Primary nonfunction. Is there a contribution from the back table bath?
A persistent problem in orthotopic liver transplantation (OLT) is primary nonfunction (PNF) of the hepatic allograft. In most instances the cause of the failure is unknown. In an attempt to minimize these graft failure, modifications in the procurement and operative procedure have been investigated. One change in the procedure at the University of Nebraska Medical Center has been the monitoring of the temperature of the fluid in the back table bath during preparation of the donor liver. Our initial procedure involved creating an ice slurry of lactated Ringer's solution and ice slush in which the donor liver was then prepared. The temperature of this ice slurry was retrospectively found to be from -3 degrees C to -1 degrees C (group I). In this group there was a higher-than-expected incidence of PNF. To investigate whether the temperature of the back table bath influenced the incidence of PNF, beginning with transplant No. 42 the preparation of the back table bath was modified. The bath was created by adding a small amount of PlasmaLyte slush to 2 L of PlasmaLyte (group II). The temperature of the bath was maintained at 2-4 degrees C. Data were collected on 100 consecutive liver transplants. All transplants were performed using standard techniques, the operation for the two groups differing only as described above. Transaminase levels were followed as an index of the allograft function and were expected to begin to normalize within 2-3 days after transplantation. While both groups display this trend, transaminase levels in group II were significantly lower postoperatively than group I levels (P less than 0.05). Preoperative values were similar. There were 7 PNFs in group I; 0 in group II (P less than 0.005). We feel that the change in the back table procedure has positively influenced the function of the hepatic allografts, and we conclude that transplant centers need to monitor the temperature at which all allografts are stored and prepared, and the cognizant that this may influence the postoperative function of the transplanted liver.
Kennedy
E M
EM
Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.
Wood
R P
RP
Shaw
B W
BW
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D002675:Child, Preschool; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007552:Isotonic Solutions; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000379:methods* / Q000502:physiology; D009926:Organ Preservation / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D000077325:Ringer's Lactate; D013696:Temperature
D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase