title: Increase in survival of liver grafts after rinsing with warm Ringer's solution due to improvement of hepatic microcirculation.
abstract: Temperature increases membrane fluidity and decreases vascular resistance in isolated organs. Therefore, these studies were designed to determine if a rinse with warm buffer could increase survival time in the rat model of orthotopic liver transplantation by improving hepatic microcirculation. Brief periods of warm ischemia (3-8 min) did not damage the liver as indexed by minimal release of LDH. Survival of rats for 30 days was greater than 90% in this model when livers were stored for 1 hr in Ringer's solution; yet grafts stored for 8 hr in Euro-Collins solution and rinsed with 20 ml of cold (0-4 degrees C) Ringer's solution survived postoperatively only around 3 days. However, livers stored for 8 hr in Euro-Collins and rinsed with 20 ml of warm (37 degrees C) Ringer's survived longer than 30 days (i.e., permanently). Serum transaminase levels reached peak values around 6000 U/L one day postoperatively in the cold-rinsed group, and liver injury assessed histologically was substantial. Under these conditions, pulmonary infiltration of inflammatory cells was observed in about 23% of lung tissue examined and was associated with massive bleeding. Following a warm rinse, however, maximal SGOT levels and injury to both liver and lung were reduced significantly by 80-90% 24 hr postoperatively. Moreover, the warm rinse improved hepatic microcirculation. It accelerated blood flow into the liver approximately two-fold, as indexed by the half-time of changes in hemoglobin reflectance from the liver surface, improved the distribution of colloidal carbon in the organ observed macroscopically, and decreased vascular resistance by over 50%. These data support the hypothesis that a brief rinse of liver grafts with warm buffer markedly improves the hepatic microcirculation, leading to dramatic improvement in graft survival. This work demonstrates clearly that a brief warm rinse may be useful clinically in liver transplantation.
authors.affiliation: Department of Pharmacology, University of North Carolina, Chapel Hill 27599-7365.
authors.forename: Y
authors.initials: Y
authors.lastname: Takei
authors.forename: W S
authors.initials: WS
authors.lastname: Gao
authors.forename: T
authors.initials: T
authors.lastname: Hijioka
authors.forename: E
authors.initials: E
authors.lastname: Savier
authors.forename: K A
authors.initials: KA
authors.lastname: Lindert
authors.forename: J J
authors.initials: JJ
authors.lastname: Lemasters
authors.forename: R G
authors.initials: RG
authors.lastname: Thurman
mesh_terms: D000818:Animals; D003080:Cold Temperature; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D000860:Hypoxia / Q000503:physiopathology; D007552:Isotonic Solutions; D008099:Liver / Q000098:blood supply* / Q000166:cytology / Q000201:enzymology; D016031:Liver Transplantation / Q000379:methods / Q000502:physiology*; D008168:Lung / Q000473:pathology; D008833:Microcirculation / Q000502:physiology; D008954:Models, Biological; D009926:Organ Preservation; D010477:Perfusion; D051381:Rats; D011917:Rats, Inbred Lew; D000077331:Ringer's Solution; D013696:Temperature; D014655:Vascular Resistance / Q000502:physiology
chemical_list: D007552:Isotonic Solutions; D000077331:Ringer's Solution