title: Liver transplantation from non-heart beating donors in rats: influence of viscosity and temperature of initial flushing solutions on graft function.
abstract: BACKGROUND
  We evaluated the effect of warm (37 degrees C) versus cold (4 degrees C) solutions as the initial flush for liver preservation from non-heart beating donors in rats.
  
  
  METHODS
  An initial flush was performed just before donor hepatectomy with cold or warm University of Wisconsin solution (UW), UW without hydroxyethyl starch, sodium lactobionate sucrose solution, or lactated Ringer's solution as the control group. A separate group also used as control received no initial flushing. Liver transplantation was performed, and the graft function was determined by survival and assessment of enzyme release. The viscosity of each solution and the vascular resistance of the graft were measured.
  
  
  RESULTS
  The 7-day survival rate was 83% and 100% in the warm and cold sodium lactobionate sucrose solution groups and 60% and 50% in the warm and cold lactated Ringer's solution groups, respectively. In the no-initial-flush group, rats did not survive. The 7-day survival rate was 67% and 0% in the warm and cold UW groups, respectively. Eliminating the hydroxyethyl starch from the cold UW improved the survival to 67%. Serum alanine aminotransferase levels 1 day after transplantation in the no-initial-flush and the cold UW groups were significantly higher than those of the remaining groups. At 4 degrees C the viscosity was higher in the UW (86.2 cp) compared to hydroxyethyl starch-free UW solution (30.9 cp), lactated Ringer's solution (24.5 cp), and sodium lactobionate sucrose solution (32.7 cp). The viscosity of UW at 37 degrees C was 34.7 cp. Vascular resistance correlated well with the viscosity. Livers flushed with solutions with a low viscosity showed lower vascular resistance than those flushed with cold UW and led to better survival.
  
  
  CONCLUSIONS
  These data suggest that the viscosity of the initial flushing solution may play an important role in determining the outcome of organ procurement from non-heart beating donors.
authors.affiliation: Department of Surgery, Stanford University Medical Center, California, USA.
authors.forename: T
authors.initials: T
authors.lastname: Tojimbara
authors.forename: W N
authors.initials: WN
authors.lastname: Wicomb
authors.forename: R
authors.initials: R
authors.lastname: Garcia-Kennedy
authors.forename: W
authors.initials: W
authors.lastname: Burns
authors.forename: M
authors.initials: M
authors.lastname: Hayashi
authors.forename: G
authors.initials: G
authors.lastname: Collins
authors.forename: C O
authors.initials: CO
authors.lastname: Esquivel
mesh_terms: D000241:Adenosine / Q000494:pharmacology; D000410:Alanine Transaminase / Q000097:blood; D000493:Allopurinol / Q000494:pharmacology; D000818:Animals; D002746:Chlorpromazine / Q000494:pharmacology; D004187:Disaccharides / Q000494:pharmacology; D005978:Glutathione / Q000494:pharmacology; D006085:Graft Survival / Q000187:drug effects; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology; D007328:Insulin / Q000494:pharmacology; D007552:Isotonic Solutions / Q000494:pharmacology; D019344:Lactic Acid / Q000494:pharmacology; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality / Q000473:pathology; D008297:Male; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions; D011887:Raffinose / Q000494:pharmacology; D051381:Rats; D017208:Rats, Wistar; D000077331:Ringer's Solution; D012996:Solutions / Q000494:pharmacology*; D013395:Sucrose / Q000494:pharmacology / Q000031:analogs & derivatives; D015996:Survival Rate; D013696:Temperature; D014655:Vascular Resistance / Q000187:drug effects; D014783:Viscosity
chemical_list: D004187:Disaccharides; D006895:Hydroxyethyl Starch Derivatives; D007328:Insulin; D007552:Isotonic Solutions; D019188:Organ Preservation Solutions; D012996:Solutions; C055206:University of Wisconsin-lactobionate solution; C067074:sodium lactobionate sucrose solution; D019344:Lactic Acid; D013395:Sucrose; D000493:Allopurinol; D000077331:Ringer's Solution; D000410:Alanine Transaminase; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose; D002746:Chlorpromazine