Improved microcirculation by low-viscosity histidine- tryptophan-ketoglutarate graft flush and subsequent cold storage in University of Wisconsin solution: results of an orthotopic rat liver transplantation model.
As previously shown in a model of isolated rat liver perfusion, the combined use of an initial graft flush with low-viscosity histidine-tryptophan-ketoglutarate (HTK) solution followed by cold storage in University of Wisconsin (UW) solution markedly improved the preservation during an extended cold storage period. In this study, we aimed to transfer our results into an in vivo model of orthotopic rat liver transplantation, and to elucidate the potential mechanism of the improved preservation by focusing on the hepatic microcirculation. Livers were harvested from male Wistar rats. Aortic perfusion with a pressure of 100 cm H(2)O was performed with either UW (group UW) or HTK (groups UW and HTK_UW), followed by additional back-table perfusion with UW (group HTK_UW). After 20-h cold storage at 4 degrees C, livers were orthotopically transplanted with reconstructing the hepatic artery. As measured by bile flow and liver enzymes, HTK flush followed by UW storage was superior compared to single use of either UW or HTK solution. The hepatic microcirculation was significantly improved, as shown by the increased percentage of reperfused sinusoids and reduced sinusoidal leucostasis. HTK and UW effectively reduce ischaemia-reperfusion injury after liver transplantation. By combining the comparative advantages of both solutions, a cumulative effect resulting in an improved preservation was shown. Thus, this mechanism improves microcirculatory reperfusion.
Olschewski
Peter
P
Clinic for General, Visceral and Transplantation Surgery, Charité Campus Virchow-Klinikum, University Medicine Berlin, Berlin, Germany. peter.olschewski@charite.de
Hunold
Gerhard
G
Eipel
Christian
C
Neumann
Ulf
U
Schöning
Wenzel
W
Schmitz
Volker
V
Vollmar
Brigitte
B
Neuhaus
Peter
P
Puhl
Gero
G
D000241:Adenosine; D000493:Allopurinol; D000818:Animals; D001219:Aspartate Aminotransferases / Q000032:analysis; D001646:Bile / Q000378:metabolism*; D002314:Cardioplegic Solutions; D053148:Caspase 3 / Q000378:metabolism; D005947:Glucose; D005978:Glutathione; D007328:Insulin; D008099:Liver / Q000201:enzymology; D008102:Liver Circulation / Q000502:physiology*; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008353:Mannitol; D008833:Microcirculation / Q000502:physiology*; D009926:Organ Preservation; D019188:Organ Preservation Solutions; D011189:Potassium Chloride; D011343:Procaine; D011887:Raffinose; D051381:Rats; D017208:Rats, Wistar; D014783:Viscosity
C039984:Bretschneider cardioplegic solution; D002314:Cardioplegic Solutions; D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D008353:Mannitol; D011343:Procaine; D000493:Allopurinol; D011189:Potassium Chloride; D001219:Aspartate Aminotransferases; D053148:Caspase 3; D005978:Glutathione; D005947:Glucose; D000241:Adenosine; D011887:Raffinose