Liver conditioning after cardiac arrest: the use of normothermic recirculation in an experimental animal model

Transpl Int. 1998;11(6):424-32. doi: 10.1007/s001470050169.

Abstract

The aim of this study was to compare the possible role of normothermic recirculation with the role of liver transplants from non-heart-beating donor pigs after 20 min of cardiac arrest. Three groups were studied, of which two were control groups: group 1, in which the liver was harvested from a heart-beating donor; group 2, in which the liver was harvested after a period of cardiac arrest followed by total body cooling; and group 3, in which the liver was procured as in group 2, but including a period of 30 min of cardiopulmonary bypass and tissue oxygenation at 37 degrees C before total body cooling. Survival at 5 days; endothelial (hyaluronic acid) and hepatocellular damage (AST, ALT, and alpha-GST); adenine nucleotides (energy charge), and histological changes were evaluated. Normothermic recirculation during 30 min showed a significant effect on survival (p = .03), endothelial damage (p < .05), and histological changes after reperfusion (p = .04). Cardiopulmonary bypass significantly increased the energy charge during the normothermic recirculation period (p = .001). Moreover, this study shows that a significant survival (100%) can be achieved with a liver allograft after 20 min of cardiac arrest. Although the liver suffers a major insult in terms of endothelial damage and hepatocellular damage, lesions caused by the ischemic injury are reversible. Histological changes also indicate lesion reversibility, since they almost disappear after 5 days.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenine Nucleotides / metabolism
  • Alanine Transaminase / blood
  • Animals
  • Aspartate Aminotransferases / blood
  • Endothelium / pathology
  • Energy Metabolism
  • Glutathione Transferase / blood
  • Graft Survival
  • Heart Arrest, Induced
  • Hyaluronic Acid / metabolism
  • Liver Circulation / physiology*
  • Liver Transplantation* / pathology
  • Liver Transplantation* / physiology
  • Models, Biological
  • Temperature
  • Time Factors
  • Tissue Donors

Substances

  • Adenine Nucleotides
  • Hyaluronic Acid
  • Glutathione Transferase
  • Aspartate Aminotransferases
  • Alanine Transaminase