title: Liver conditioning after cardiac arrest: the use of normothermic recirculation in an experimental animal model.
abstract: The aim of this study was to compare the possible role of normothermic recirculation with the role of liver transplants from non-heart-beating donor pigs after 20 min of cardiac arrest. Three groups were studied, of which two were control groups: group 1, in which the liver was harvested from a heart-beating donor; group 2, in which the liver was harvested after a period of cardiac arrest followed by total body cooling; and group 3, in which the liver was procured as in group 2, but including a period of 30 min of cardiopulmonary bypass and tissue oxygenation at 37 degrees C before total body cooling. Survival at 5 days; endothelial (hyaluronic acid) and hepatocellular damage (AST, ALT, and alpha-GST); adenine nucleotides (energy charge), and histological changes were evaluated. Normothermic recirculation during 30 min showed a significant effect on survival (p = .03), endothelial damage (p < .05), and histological changes after reperfusion (p = .04). Cardiopulmonary bypass significantly increased the energy charge during the normothermic recirculation period (p = .001). Moreover, this study shows that a significant survival (100%) can be achieved with a liver allograft after 20 min of cardiac arrest. Although the liver suffers a major insult in terms of endothelial damage and hepatocellular damage, lesions caused by the ischemic injury are reversible. Histological changes also indicate lesion reversibility, since they almost disappear after 5 days.
authors.affiliation: Department of Surgery, Hospital Clínic of Barcelona, Spain. jcvalde@medicina.ub.es
authors.forename: J C
authors.initials: JC
authors.lastname: García-Valdecasas
authors.forename: J
authors.initials: J
authors.lastname: Tabet
authors.forename: R
authors.initials: R
authors.lastname: Valero
authors.forename: P
authors.initials: P
authors.lastname: Taurá
authors.forename: R
authors.initials: R
authors.lastname: Rull
authors.forename: F
authors.initials: F
authors.lastname: García
authors.forename: E
authors.initials: E
authors.lastname: Montserrat
authors.forename: F X
authors.initials: FX
authors.lastname: González
authors.forename: J
authors.initials: J
authors.lastname: Ordi
authors.forename: J
authors.initials: J
authors.lastname: Beltran
authors.forename: M A
authors.initials: MA
authors.lastname: López-Boado
authors.forename: R
authors.initials: R
authors.lastname: Deulofeu
authors.forename: J
authors.initials: J
authors.lastname: Angás
authors.forename: A
authors.initials: A
authors.lastname: Cifuentes
authors.forename: J
authors.initials: J
authors.lastname: Visa
mesh_terms: D000227:Adenine Nucleotides / Q000378:metabolism; D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D001219:Aspartate Aminotransferases / Q000097:blood; D004727:Endothelium / Q000473:pathology; D004734:Energy Metabolism; D005982:Glutathione Transferase / Q000097:blood; D006085:Graft Survival; D006324:Heart Arrest, Induced; D006820:Hyaluronic Acid / Q000378:metabolism; D008102:Liver Circulation / Q000502:physiology*; D016031:Liver Transplantation / Q000473:pathology / Q000502:physiology; D008954:Models, Biological; D013696:Temperature; D013997:Time Factors; D014019:Tissue Donors
chemical_list: D000227:Adenine Nucleotides; D006820:Hyaluronic Acid; D005982:Glutathione Transferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase