Fasted state impedes recovery of porcine hepatic oxygen consumption after warm hepatic ischemia.
The most effective means to prepare the hepatic donor liver for harvest, preservation, and transplantation are not known. Studies have shown that in combination with an injury to the liver, fasting reduces hepatic function. This study randomized 20 market pigs, 20 to 45 kg, to an overnight fast (fed group) or a 42-hour fast (fasted group). Under general anesthetic perfusion of the portal vein and hepatic artery were controlled. Studies were performed at high flow (30 ml/min/kg portal flow and 10 ml/min/kg arterial flow) and after a 90-minute period of warm ischemia (no flow). Flow was restored at 25% of the original (low flow), then increased to 50% of the original (medium flow). After the ischemic insult, the fed group improved hepatic oxygen consumption at a faster rate than the fasted group (p less than 0.05 by ANOVA). In addition, significant differences were noted between the fed and fasted groups in the amount of insulin delivered by the portal venous system to the liver (p less than 0.001 by ANOVA). Hepatic oxygen consumption was related to insulin delivery (r2 = 0.46; p less than 0.001) for both groups. The data suggest that acute changes in the nutritional status of both the donor and the recipient may affect hepatic recovery from ischemia.
Division of Trauma and Critical Care Surgery, Henry Ford Hospital, Detroit, Mich. 48202.
J
J
Fath
B
B
Parkes
V
V
Sorensen
J
J
Gaymer
M
M
Macdonald
R
R
Warren
D
D
Tkach
F
F
Fernandez
D
D
Block
F
F
Konstantinides
D000596:Amino Acids / Q000097:blood / Q000378:metabolism; D000818:Animals; D005215:Fasting; D006358:Hot Temperature; D007511:Ischemia / Q000378:metabolism*; D008099:Liver / Q000378:metabolism*; D008102:Liver Circulation; D010101:Oxygen Consumption; D011169:Portal Vein; D012016:Reference Values; D013552:Swine
D000596:Amino Acids