Preservation of porcine non-heart-beating donor livers by sequential cold storage and warm perfusion.
BACKGROUND
Normothermic perfusion has been shown to resuscitate and maintain viability of non-heart-beating donor (NHBD) livers that have undergone significant warm ischemic injury. However, the logistics of clinical organ retrieval are complex, and a period of cold storage before warm preservation would simplify the process. We have investigated the effects of short duration of cold preservation before normothermic preservation on the function of porcine NHBD livers.


METHODS
Porcine livers were subjected to 60 minutes of warm ischemia and then assigned to the following groups: group W (n=5), normothermic preservation for 24 hours; and group C (n=4), cold preservation in University of Wisconsin solution for 4 hours followed by normothermic preservation for 20 hours (total preservation time 24 hours). Outcome parameters that were measured included bile production, serum transaminases and hyaluronic acid levels (cellular damage), and base deficit and glucose use (metabolic function).


RESULTS
Group W livers had superior bile production, metabolic activity (base deficit and greater glucose use), and less evidence of hepatocellular damage (alanine aminotransferase, aspartate aminotransferase), and sinusoidal endothelial cell dysfunction (hyaluronic acid). Group C livers showed greater necrosis and destruction of architecture on histology.


CONCLUSIONS
Normothermic perfusion failed to resuscitate porcine livers after 60 minutes of warm ischemia and 4 hours of cold preservation. Even a short period of cold ischemia is significantly deleterious to the function of ischemically damaged (NHBD) livers.
Reddy
Srikanth P
SP
Nuffield Department of Surgery, University of Oxford, Oxford, UK.
Bhattacharjya
Shantanu
S
Maniakin
Nikolai
N
Greenwood
Joanne
J
Guerreiro
Dino
D
Hughes
David
D
Imber
Charles J
CJ
Pigott
David W
DW
Fuggle
Susan
S
Taylor
Richard
R
Friend
Peter J
PJ
D000136:Acid-Base Equilibrium; D000818:Animals; D001646:Bile / Q000378:metabolism; D003080:Cold Temperature; D005165:Factor V / Q000378:metabolism; D006085:Graft Survival; D006323:Heart Arrest; D006358:Hot Temperature; D007511:Ischemia / Q000378:metabolism / Q000473:pathology*; D008099:Liver / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation; D009926:Organ Preservation / Q000379:methods*; D010477:Perfusion; D034421:Sus scrofa; D014019:Tissue Donors
D005165:Factor V