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Chapter category: Transplant
Metabolic Management
Chapter authors:
Sufan Chien
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The removal of an organ, which is subjected to an unnatural environment necessitates special management strategies that differ from in vivo management. The normal human body and the bodies of other mammalian animals involve complex neurologic and hormonal regulatory systems. Adequate substrates and oxygen supplies allow these system to adjust the body’s function and its metabolism to a wide variety of external and internal environmental changes. Every organ has a vital role in the control of one or more fluid constituents and the efficient exchange of energy and substrates between organs is crucial for inducing this steady state. Once an organ is separated from the body, the regulatory ability becomes very limited or lost and the survival of the organ becomes dependent upon the correct and careful regulation of the new artificial environment. Metabolic regulation is involved in nearly all aspects of organ preservation, a subject that is overlapped in other chapters of this book. The scope of this particular chapter varies according to the methods used. If a single‑flush preservation is used, the major pathophysiology is reduced energy supply and accumulation of metabolic wastes. Thus, either inhibition of tissue metabolism or supplement of energy substrates along with removal of metabolic wastes become the main strategy for extended organ survival. On the other hand, if perfusion is used, whether it is continuous or intermittent, the above problems become less important and the management concerns shift to overcoming the damage caused by perfusion itself. Our understanding of the physiology of isolated organs is superficial and fragmented because our knowledge of normal organ metabolism is still relatively limited. Moreover, due to the rapid advancement of molecular biology, the metabolic pathway is not currently a favorable research topic,1 leaving many questions unanswered. In this chapter, we will briefly review previous work in these areas plus some findings in the author’s laboratory describing his research team’s effort to extend organ and tissue survival time during ischemia. Because many topics are also covered in other chapters, these topics will be mentioned only briefly. Metabolic management during reperfusion will not be described here because a separate chapter is dedicated to reperfusion damage.
Sufan Chien
Department of Surgery, University of Louisville
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Sufan Chien
The removal of an organ, which is subjected to an unnatural environment necessitates special management strategies that differ from in vivo management. The normal human body and the bodies of other ma...
