title: Optimal time for hypothermic reconditioning of liver grafts by venous systemic oxygen persufflation in a large animal model.
abstract: BACKGROUND
  Quality of cold-stored livers declines beyond 12 hr of ischemia, increasing the risk of primary dysfunction. Here we evaluate the potential and optimal treatment interval of gaseous oxygen persufflation for grafts reconditioning after long storage times in an experimental pig liver model.
  
  
  METHODS
  Porcine livers (n=6/group) were cold stored at 4°C for 18 hr in histidine-tryptophan-ketoglutarate solution. Hypothermic reconditioning (HR) was performed in some livers, by insufflation of gaseous oxygen through the caval vein for 1, 2, or 3 hr subsequent to cold storage. Liver integrity was assessed by controlled in vitro reperfusion with autologous blood.
  
  
  RESULTS
  HR resulted in a 40% to 50% reduction of serum levels of aspartate aminotransferase, lactate dehydrogenase, and tumor necrosis factor-α with a maximal effect after 2 hr of HR (P<0.05). Functional parameters (bile production, cholinesterase and energetic recovery) were likewise enhanced (P<0.05). Two hours of HR also improved hepatic arterial flow and abrogated the postischemic increase in portal venous perfusion resistance compared with untreated (P<0.05). Gene expression of Toll-like receptor-4 was reduced by 2 hr of HR as was platelet adherence in the reperfused graft (P<0.05), in line with a trend toward lower expression of von Willebrand factor.
  
  
  CONCLUSIONS
  HR effectively ameliorated graft dysfunction after extended preservation of porcine livers. Two hours of "a posteriori" treatment provide the maximal effect and are recommended for further application.
authors: Department for General, Visceral and Transplantation Surgery, University Hospital of Essen, Essen, Germany.
authors: Martina
authors: M
authors: Koetting
authors: Bastian
authors: B
authors: Lüer
authors: Patrik
authors: P
authors: Efferz
authors: Andreas
authors: A
authors: Paul
authors: Thomas
authors: T
authors: Minor
mesh_terms: D000818:Animals; D015925:Cryopreservation / Q000379:methods*; D005260:Female; D006639:Histidine / Q000378:metabolism; D007656:Ketoglutaric Acids / Q000378:metabolism; D008099:Liver / Q000098:blood supply / Q000502:physiology*; D016031:Liver Transplantation; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions / Q000737:chemistry; D010100:Oxygen / Q000378:metabolism*; D010477:Perfusion; D013552:Swine; D051197:Toll-Like Receptor 4 / Q000378:metabolism; D014364:Tryptophan / Q000378:metabolism; D014841:von Willebrand Factor / Q000378:metabolism
chemical_list: D007656:Ketoglutaric Acids; D019188:Organ Preservation Solutions; D051197:Toll-Like Receptor 4; D014841:von Willebrand Factor; D006639:Histidine; D014364:Tryptophan; D010100:Oxygen