Liver protection by hypothermic perfusion at different temperatures during total vascular exclusion.
BACKGROUND
In situ hypothermic perfusion (HP) can be applied to attenuate ischemia and reperfusion (I/R) injury during liver resection under total vascular exclusion (TVE). This study examines the protective effect of cooling by HP at 20 and 28 degrees C as compared with no HP during TVE in a porcine liver I/R model.


METHODS
Twenty-one pigs underwent 60 min TVE of the liver followed by 24 h reperfusion. HP was performed via the portal vein using ringerlactate solution of 4 degrees C. Pigs were assigned to three groups: TVE without HP (no-HP, n=9), TVE with HP at 28 degrees C (HP-28, n=6) and TVE with HP at 20 degrees C (HP-20, n=6).


RESULTS
Perfusion volumes during TVE were 5.1+/-0.5 and 17.3+/-1.7 l in HP-28 and HP-20, respectively (P<0.05). Aspartate aminotransferase (AST) after 24 h reperfusion was 1172+/-440 U/l in no-HP as compared with 223+/-69 and 180+/-22 U/l in HP-28 and HP-20, respectively (P<0.05). No differences in liver function or histopathology were found between the HP-28 and HP-20 groups.


CONCLUSIONS
HP at 20 degrees C is equally effective in preserving liver function and preventing hepatocellular injury under TVE as compared with HP at 28 degrees C. HP at 28 degrees C is advised, because of the lesser perfusion volume necessary for cooling of the liver.
Dinant
Sander
S
Department of Surgery (Surgical Laboratory), Academic Medical Center, Amsterdam, the Netherlands.
van Veen
Suzanne Q
SQ
Roseboom
Hendrik J
HJ
van Vliet
Arlène K
AK
van Gulik
Thomas M
TM
D000818:Animals; D001219:Aspartate Aminotransferases / Q000378:metabolism; D004847:Epithelial Cells / Q000378:metabolism / Q000473:pathology; D006439:Hemodynamics / Q000502:physiology; D006498:Hepatectomy / Q000379:methods; D007036:Hypothermia, Induced; D007249:Inflammation / Q000473:pathology / Q000503:physiopathology; D015850:Interleukin-6 / Q000378:metabolism; D008099:Liver / Q000098:blood supply* / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D015427:Reperfusion Injury / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D013552:Swine; D013696:Temperature; D013997:Time Factors
D015850:Interleukin-6; D001219:Aspartate Aminotransferases