Non-invasive measurement of hepatic oxygenation by an oxygen electrode in human orthotopic liver transplantation.
Precise evaluation of graft reperfusion is difficult in clinical liver transplantation. The oxygen electrode (OE) is a novel technique to detect blood flow indirectly by measuring the quantity of oxygen which can diffuse from the hepatic tissue to the surface electrode. Application of the surface OE does not influence the liver blood flow or parenchymal perfusion. Adequate graft oxygenation is essential to the outcome of organ transplantation and has not previously been analysed intra-operatively in liver transplant recipients. The OE was applied to the surface of the graft intra-operatively in 22 human liver grafts after restoring portal vein and hepatic artery inflow. OE readings were compared with liver blood flow using an electromagnetic flowmeter (EMF). Intra-operative haemodynamics and donor organ parameters known to influence graft function were correlated with the OE readings. There was a significant correlation (r=0.89; p<0.001, n=14) between tissue oxygenation using the OE and total liver blood flow measured by EMF. The tissue oxygenation measurements were reproducible with a coefficient of variation of 5%. The hepatic tissue oxygenation increased significantly from baseline following venous reperfusion of the graft (282+/-23 vs 3107+/-288 (+/-SE) nA, p<0.001). Hepatic arterial revascularisation resulted in a significant (p<0.001) increase of 41+/-7% in liver oxygen perfusion. There was significant negative correlation (r=0.80, p<0.001, n=22) between cold ischaemic time and graft tissue oxygenation. The OE provides a reliable, cheap and non-invasive method of monitoring liver graft oxygenation and perfusion during transplantation.
Seifalian
A M
AM
University Department of Surgery and Liver Transplantation, Royal Free and University College Medical School, University College London and The Royal Free Hospital, Pond Street, London NW3 2QG, UK. a.seifalian@rfc.ucl.ac.uk
Mallett
S
S
Piasecki
C
C
Rolles
K
K
Davidson
B R
BR
D000328:Adult; D004566:Electrodes; D005260:Female; D006801:Humans; D008099:Liver / Q000378:metabolism*; D008102:Liver Circulation; D016031:Liver Transplantation; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D010100:Oxygen / Q000378:metabolism*
D010100:Oxygen