Reduction of rewarming injury of the hepatic graft by a heat insulator.
BACKGROUND
The deleterious effect of rewarming in orthotopic liver transplantation is recognized. This study examined the significance of rewarming the hepatic allograft, and the possibility of using a heat insulator to reduce rewarming injury.


METHODS
After total hepatectomy in rats with in situ perfusion by chilled (4 degrees C) lactated Ringer's solution, the livers were divided into four groups of ten each: group 1, 4-h preservation in chilled Ringer's solution and 15 min of rewarming; group 2, 6-h preservation in chilled Ringer's solution; group 3, 6-h preservation in chilled Ringer's solution and 15 min of rewarming; group 4, 6-h preservation in chilled Ringer's solution and 15 min of rewarming with a heat insulator. Glutamic-pyruvic transaminase (GPT) and N-acetyl-beta-glucosaminidase (NAG) concentrations in the final graft effluent, and the amount of adenosine 5'-triphosphate (ATP) in liver tissue after preservation, were measured.


RESULTS
GPT and NAG concentrations in the final graft effluent of group 3 were higher than those of group 2 (P < 0.01), whereas values in group 4 were lower than those of group 3 (P < 0.05). The final ATP concentration in group 3 was significantly lower than that in group 2 (P < 0.01), whereas the value in group 4 was significantly higher than that of group 3 (P < 0.01).


CONCLUSIONS
Rewarming diminishes the viability of a liver graft with degradation of ATP, and a heat insulator reduces rewarming injury.
Wakiyama
S
S
Department of Surgery II, Kyushu University, Faculty of Medicine, Fukuoka, Japan.
Yanaga
K
K
Soejima
Y
Y
Nishizaki
T
T
Sugimachi
K
K
D000118:Acetylglucosaminidase / Q000378:metabolism; D000410:Alanine Transaminase / Q000378:metabolism; D000818:Animals; D001831:Body Temperature; D008099:Liver / Q000293:injuries / Q000378:metabolism / Q000502:physiology; D016031:Liver Transplantation; D051381:Rats; D011917:Rats, Inbred Lew; D017694:Rewarming / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors
D000410:Alanine Transaminase; D000118:Acetylglucosaminidase