Effect of in situ hypothermic perfusion on intrahepatic pO2 and reactive oxygen species formation after partial hepatectomy under total hepatic vascular exclusion in pigs.
OBJECTIVE
This study examined attenuation of ischemia and reperfusion (I/R) induced liver injury during liver resections by hypothermic perfusion of the liver under total hepatic vascular exclusion (THVE).


METHODS
Reactive oxygen species (ROS) formation, microcirculatory integrity and endothelial cell damage were investigated. Left hemihepatectomy (LHX) was performed without in situ perfusion (control-LHX, n = 5) or with concomitant in situ perfusion with hypothermic (4 degrees C) Ringer-glucose (cold-LHX, n = 5) or normothermic (38 degrees C) Ringer-glucose (warm-LHX, n = 5). Glutathione (GSH) and malondialdehyde (MDA) concentrations, tissue pO2 levels and hyaluronic acid (HA) uptake capacity were determined.


RESULTS
After cold, warm and control-LHX, 24 h survival was 5/5, 0/5 and 3/5, respectively. GSH levels were best preserved after cold-LHX during reperfusion. MDA levels increased in all groups without significant differences between the groups during reperfusion. Tissue pO2 levels increased after cold-LHX whereas after warm-LHX and control-LHX, pO2 levels decreased during reperfusion. HA uptake capacity remained normal after cold-LHX. After warm-LHX and control-LHX, HA uptake capacity decreased after 6 h of reperfusion but recovered after 24 h of reperfusion in the control-LHX group.


CONCLUSIONS
Moderate hypothermic perfusion protects the liver from I/R injury during LHX under THVE. This protective effect depended on maintenance of liver microcirculation rather than a reduction in ROS formation.
Heijnen
Bob H M
BH
Department of Surgery, Surgical Laboratory, Academic Medical Center, Amsterdam, The Netherlands. b.h.heijnen@amc.uva.nl
Straatsburg
Irene H
IH
Kager
Liesbeth M
LM
van der Kleij
Ad J
AJ
Gouma
Dirk J
DJ
van Gulik
Thomas M
TM
D000818:Animals; D005978:Glutathione / Q000378:metabolism; D006498:Hepatectomy; D007036:Hypothermia, Induced; D008099:Liver / Q000378:metabolism* / Q000601:surgery; D008102:Liver Circulation / Q000502:physiology*; D008315:Malondialdehyde / Q000378:metabolism; D023421:Models, Animal; D010100:Oxygen / Q000378:metabolism*; D017382:Reactive Oxygen Species / Q000378:metabolism*; D015427:Reperfusion Injury / Q000378:metabolism*; D013552:Swine
D017382:Reactive Oxygen Species; D008315:Malondialdehyde; D005978:Glutathione; D010100:Oxygen