Fibrinolytic preflush upon liver retrieval from non-heart beating donors to enhance postpreservation viability and energetic recovery upon reperfusion.
BACKGROUND
Our objective was to evaluate graft equilibration with high viscosity (University of Wisconsin solution [UW]) or low viscosity (Bretschneider's histidine-tryptophan-ketoglutarate [HTK]) during liver procurement from non-heart beating donors (NHBD) and the potential impact of a preceding fibrinolysis with streptokinase on postpreservation viability.


METHODS
After 60 min of cardiac arrest, rat livers were perfused by gravity (60 cm H2O) via the portal vein with either 60 ml of HTK, 20 ml of UW, or 20 ml of Ringer's solution (22 degrees C including 7500U of streptokinase) and, subsequently, 20 ml of UW. After 24 h of storage at 4 degrees C, viability of the livers was assessed upon isolated reperfusion in vitro.


RESULTS
Magnetic resonance imaging revealed severe perfusion deficits, which were mildly attenuated with HTK, upon flush-out with UW. After preflush with streptokinase, a mostly homogenous distribution of the preservation solution was observed throughout the liver tissue. The choice of the flush-out solution (UW or HTK) had no influence on parenchymal enzyme leakage, hepatic bile production, or tissue levels of ATP after reperfusion of the livers. Fibrinolytic preflush, however, resulted in a relevant and significant improvement of structural integrity as well as functional and metabolic recovery.


CONCLUSIONS
Compromised vascular tissue perfusion upon organ harvest in NHBD triggers graft dysfunction after cold storage and can easily be circumvented by temporary fibrinolysis before graft retrieval.
Minor
T
T
Surgical Research Division, University Clinic of Surgery, University of Bonn, 53127 Bonn, Germany. umc20001@uni-bonn.de
Hachenberg
A
A
Tolba
R
R
Pauleit
D
D
Akbar
S
S
D000241:Adenosine / Q000627:therapeutic use; D000493:Allopurinol / Q000627:therapeutic use; D000818:Animals; D004734:Energy Metabolism; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005947:Glucose / Q000627:therapeutic use; D005978:Glutathione / Q000627:therapeutic use; D006323:Heart Arrest; D007328:Insulin / Q000627:therapeutic use; D008099:Liver / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D019188:Organ Preservation Solutions / Q000627:therapeutic use; D011189:Potassium Chloride / Q000627:therapeutic use; D011300:Preoperative Care; D011343:Procaine / Q000627:therapeutic use; D011887:Raffinose / Q000627:therapeutic use; D051381:Rats; D017208:Rats, Wistar; D015427:Reperfusion Injury / Q000175:diagnosis / Q000503:physiopathology; D013300:Streptokinase / Q000627:therapeutic use*; D014019:Tissue Donors; D014022:Tissue Survival / Q000187:drug effects; D020858:Tissue and Organ Harvesting
C039984:Bretschneider cardioplegic solution; D005343:Fibrinolytic Agents; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D008353:Mannitol; D011343:Procaine; D000493:Allopurinol; D011189:Potassium Chloride; D013300:Streptokinase; D005978:Glutathione; D005947:Glucose; D000241:Adenosine; D011887:Raffinose