The tolerance time limits of biliary tracts of liver grafts subjected to warm ischemia and cold preservation: an experimental study in swine.
OBJECTIVE
The objective of this study was to investigate the tolerance time limits of liver grafts and biliary tracts with warm ischemia to cold preservation providing experimental data to the prevent primary graft nonfunction and biliary necrosis after orthotopic liver transplantation (OLT).


METHODS
OLTs were performed in Bama miniature swine. Morphological and functional changes in the liver graft and biliary tracts were investigated after 10 minutes of warm ischemia and various durations of cold preservation.


RESULTS
When grafts were subjected to 10 minutes of warm ischemia followed by less than 16 hours of cold preservation, all animals survived 1 week; no animal died of biliary necrosis. However, when the cold preservation time exceeded 16 hours, the incidence of biliary necrosis increased significantly (P < .05) with deaths due to bile leaks. As cold preservation persisted, primary graft nonfunction and intraoperative or early postoperative deaths occurred, and all surviving animals developed biliary necrosis. When compared with the group undergoing less than 16 hours of cold preservation, the morphological scores and apoptosis index of epithelial cells of graft bile ducts were significantly increased among the group subjected to more than 16 hours of cold preservation after reperfusion (P < .05), whereas the activity of Na+-K+-ATPase and Ca2+-ATPase of graft bile ducts were reduced significantly (P < .05). Liver function tests showed the concentrations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transpeptidase, and alkaline phosphatase (ALP) decreased more slowly among the group undergoing more than 16 hours of cold preservation after operation.


CONCLUSIONS
We concluded that given 10 minutes of warm ischemia, cold preservation should be less than 16 hours to avoid early biliary necrosis; the corresponding tolerance time limit of the liver to cold preservation was less than 20 hours.
Zheng
S
S
Institute of Hepatobiliary Surgery, Southwest Hospital, The Third Military Medical University, Chongqing, China.
Feng
X
X
Qing
D
D
Chen
M
M
Dong
J
J
D000818:Animals; D001659:Biliary Tract / Q000276:immunology*; D003080:Cold Temperature; D003135:Common Bile Duct / Q000601:surgery; D007511:Ischemia; D016031:Liver Transplantation / Q000502:physiology*; D023421:Models, Animal; D009926:Organ Preservation / Q000379:methods*; D011169:Portal Vein / Q000601:surgery; D013552:Swine; D013997:Time Factors; D023001:Transplantation Tolerance; D014682:Vena Cava, Inferior / Q000601:surgery