Evaluation of ischemic injury during liver procurement from non-heart-beating donors.
The aim of this study was to assess liver viability after different periods of cardiac arrest and the predictive value of two markers of ischemia-reperfusion injury.


METHODS
A pig liver transplantation model of non-heart-beating donors was studied. Four donor groups were designed; three groups were submitted to different periods of cardiac arrest (20, 30 and 40 min), and the fourth group served as the control group (without cardiac arrest). In the non-heart-beating donor groups, normothermic recirculation was established 30 min prior to total body cooling. Aminotransferase, alpha-glutathione-S-transferase, and hyaluronic acid determinations as well as liver biopsies, were serially performed.


RESULTS
Although hepatocellular function could be preserved after 40 min of cardiac arrest, histological lesions at 5 days were considered irreversible due to the presence of a necrotic biliary tract. An overall significant relationship was found between the time period of cardiac arrest (20, 30 or 40 min) and the levels of hyaluronic acid (p = 0.004) or alpha-glutathione-S-transferase (p = 0.01) obtained during liver procurement and transplantation.


CONCLUSIONS
The period of cardiac arrest is the determinant factor of liver viability after liver transplantation from non-heart-beating donors. As early markers of endothelial or hepatocellular damage, hyaluronic acid or alpha-glutathione-S-transferase levels may help to evaluate the ischemic injury of a potential donor.
García-Valdecasas
J C
JC
Department of Surgery, Hospital Clinic of Barcelona, Spain.
Tabet
J
J
Valero
R
R
Deulofeu
R
R
Taurá
P
P
Rull
R
R
Capdevila
L
L
Cifuentes
A
A
González
F X
FX
Net
M
M
Beltran
J
J
López-Boado
M A
MA
Palacin
J
J
García
F
F
Visa
J
J
D000410:Alanine Transaminase / Q000378:metabolism; D000818:Animals; D001219:Aspartate Aminotransferases / Q000378:metabolism; D004727:Endothelium / Q000473:pathology; D005982:Glutathione Transferase / Q000378:metabolism; D006085:Graft Survival; D006323:Heart Arrest; D006820:Hyaluronic Acid / Q000378:metabolism; D007511:Ischemia / Q000201:enzymology / Q000378:metabolism / Q000473:pathology*; D008099:Liver / Q000201:enzymology / Q000378:metabolism / Q000473:pathology*; D008102:Liver Circulation; D016031:Liver Transplantation; D011237:Predictive Value of Tests; D016019:Survival Analysis; D013552:Swine; D013997:Time Factors; D014022:Tissue Survival; D009927:Tissue and Organ Procurement
D006820:Hyaluronic Acid; D005982:Glutathione Transferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase