Laparoscopic organ retrieval for living donor liver transplantation does not prevent graft injury.
The cause of transplant failure may be difficult to define. However, organ retrieval before preservation and transplantation is an important factor. Organ manipulation during harvesting, which is inevitable with most techniques, leads to injury upon reperfusion including microcirculatory disturbances. Recently, laparoscopic organ retrieval has been successfully performed for human living donor liver transplantation (LDLT). Pneumoperitoneum for laparoscopy changes the pattern of hepatic blood flow. To study the effects of pneumoperitoneum on the graft prior to cold storage, livers from Sprague-Dawley rats underwent pneumoperitoneum with an intra-abdominal pressure of 8 mm Hg for 90 minutes. Subsequently, intravital microscopy was performed to assess intrahepatic microcirculation and transaminases were measured. Serum transaminases increased 1.5-fold compared with sham controls (P < .05). Intrahepatic microcirculation was significantly disturbed immediately after pneumoperitoneum. If this is confirmed in humans, laparoscopic organ retrieval for LDLT would be expected to decrease graft quality and not be beneficial in liver transplantation.
Schemmer
P
P
Department of Surgery, Ruprecht-Karls-University, Heidelberg, Germany. peter_schemmer@med.uni-heidelberg.de
Barro-Bejarano
M
M
Mehrabi
A
A
Gebhard
M M
MM
Kraus
T
T
Büchler
M W
MW
Gutt
C N
CN
D000818:Animals; D005260:Female; D010535:Laparoscopy / Q000379:methods*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D023421:Models, Animal; D009392:Nephrectomy / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D051381:Rats; D017207:Rats, Sprague-Dawley; D020858:Tissue and Organ Harvesting / Q000379:methods*