HEPATIC HYPERTHERMIA BY TOTAL ISOLATION AND REGIONAL PERFUSION INVIVO

A pump-oxygenator and isolation-perfusion circuit were used to selectively elevate hepatic temperature in 33 dogs to either 37, 41, or 43°C. Temperatures were maintained for 10-30 min. Survival was 75% in 8 dogs after 37°C × 30 min, 40% in 10 dogs after 41°C × 30 min (not significant), 40% in 5 dogs after 43°C × 10 min (not significant), and 0% in 10 dogs after 43°C × 30 min (P ≤ 0.01). Animals subjected to 43°C × 30 min hepatic perfusion exhibited an increase in fatal intraoperative arrhythmias despite maintenance of relatively normal blood pressure, systemic temperature, blood gases, and electrolytes. Six animals (2 after 43°C × 10-min perfusion, 4 after 43°C × 30-min perfusion) developed a postoperative symptom complex of progressive obtundation, fever, oliguria, hypotension, and death. Blood cultures were negative. Laboratory values in some animals suggested hepatic necrosis and early hepatic and renal failure but did not completely explain the clinical picture observed. The most striking finding in hyperthermically perfused animals was a diffuse hepatocyte vacuolopathy which on serial liver biopsies in surviving animals progressed to ballooning degeneration then complete resolution. This study demonstrates that temperatures suitable for thermotherapy of hepatic malignancies have hepatotoxic effects which are both temperature and time dependent. Present studies attempt to modulate the toxicity of hepatic hyperthermia by use of perfusate additives. © 1979.