Decrease in core liver temperature with 10 degrees C by in situ hypothermic perfusion under total hepatic vascular exclusion reduces liver ischemia and reperfusion injury during partial hepatectomy in pigs.
OBJECTIVE
We attempted to assess liver ischemia/reperfusion injury under a mild decrease in core liver temperature of 10 degrees C by in situ hypothermic perfusion during ischemia.


METHODS
Liver ischemia was induced in pigs by total hepatic vascular exclusion with concomitant in situ perfusion with hypothermic (4 degrees C) Ringer-glucose (cold perfused group, core liver temperature maintained at 28 degrees C), with normothermic (38 degrees C) Ringer-glucose (warm perfused group) or without in situ perfusion (control group).


RESULTS
In the cold perfused, warm perfused, and control groups, 24-hour survival was 5/5, 0/5, and 3/5, respectively. Hemodynamic parameters in the cold perfused group remained stable, whereas pigs in both other groups required circulatory support. Plasma AST and interleukin-6 levels were lower in the cold perfused group than in both other groups. Hepatocellular function was best preserved in the cold perfused group as indicated by complete recovery of bile production during reperfusion and no loss of indocyanine green clearance capacity. In both other groups, bile production and indocyanine green clearance capacity were reduced significantly. The hyaluronic acid uptake capacity of pigs in the cold perfused group or control group did not differ, indicating preserved sinusoidal endothelial cell function. Histopathologic injury scores during reperfusion were significantly lower in the cold perfused group when compared to both other groups.


CONCLUSIONS
A mild decrease in core liver temperature of 10 degrees C by in situ hypothermic liver perfusion during ischemia protects the liver from ischemia/reperfusion injury. This protection appears to be related to cooling of the liver rather than to the washout of blood during perfusion.
Heijnen
Bob H M
BH
Surgical laboratory, IWO 10151, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Straatsburg
Irene H
IH
Gouma
Dirk J
DJ
van Gulik
Thomas M
TM
D000818:Animals; D001831:Body Temperature; D042783:Endothelial Cells / Q000502:physiology; D005260:Female; D006498:Hepatectomy; D007036:Hypothermia, Induced; D015850:Interleukin-6 / Q000097:blood; D007511:Ischemia / Q000517:prevention & control*; D008099:Liver / Q000098:blood supply* / Q000473:pathology; D008102:Liver Circulation; D010477:Perfusion; D015427:Reperfusion Injury / Q000517:prevention & control*; D013552:Swine
D015850:Interleukin-6