Preservation methods for liver transplantation
Bergren, C.T.; Toledo-Pereyra, L.H.; MacKenzie, G.
Boletin de la Asociacion Medica de Puerto Rico 78(10): 434-436
1986
ISSN/ISBN: 0004-4849 PMID: 3539137 Document Number: 700038
The development of optimal methods for preservation is important for the advancement of liver transplantation. This study compares hypothermic storage (HS) or hypothermic pulsatile perfusion (HPP) with various solutions. Canine livers were removed from mongrel dogs without warm ischemia and flushed with either heparinized Ringer's lactate (Control and HPP preserved groups) or the solution used for HS (TP-V) or Collins (C-2); TP-V is a hyperosmolar colloid solution containing sucrose, dextrose, and ATP-MgCl2. The type of preservation and solution for each of the experimental groups was as follows: Group I (n=7), no preservation, fresh; Group II (n=6) 24 hr. HS, TP-V; Group III (n=7) 24 hr. HS, Collins (C-2); Group IV (n=6) 24 hr. HPP. TP-V; Group V (n=6) 24 hr. HPP, Belzer; Group VI (n=3) 24 hr. HPP, albumin. After the preservation period, livers were placed on HPP at 37.degree. C with albumin-mannitol solution for 3 hours testing in an isolated liver perfusion model. Perfusate samples were taken at 1 hour intervals to assess liver fuction. LDH, SGOT, alkaline phosphatase (AP), lactic acid (LA), leucine amino peptidase (LAP), pH, AMP, ADP, and ATP were studied. Histologic studies, as well as representative HIDA scans were performed. The results of these studies indicated that pulsatile perfusion was the preferred method for preservation of liver grafts, since liver function tests were significantly impaired in the hypothermically stored group. Using our isolated perfusion test model, a greater degree of immediate cell damage was observed in groups preserved with Belzer and Collins solutions. TP-V solution with HPP appeared to give the best overall liver functional response and histologic results and is recommended as the preferred method for 24 hour liver preservation.