Differential impact of carolina rinse and university of wisconsin solutions on microcirculation, leukocyte adhesion, kupffer cell activity and biliary excretion after liver transplantation

Abstract

This quantitative in vivo fluorescence microscopy study investigated the relative impact of an optimized rinse solution (warm Carolina rinse) and that of an established storage solution (University of Wisconsin solution) on various pathomechanisms of hepatic reperfusion injury after cold storage. Syngeneic orthotopic, arterialized liver transplantation was performed in male Lewis rats after 24 hr of cold ischemia (n = 24). The four experimental groups differed according to the type of preservation/rinse solution used: University of Wisconsin solution/albumin rinse (group 1), autologous blood (just external cooling)/albumin rinse (group 2), blood/Carolina rinse (group 3) and University of Wisconsin solution/Carolina rinse (group 4). Hepatic microvascular perfusion, leukocyte accumulation and phagocytic activity of Kupffer cells were assessed by means of intravital fluorescence microscopy 30 to 90 min after reperfusion. Disturbances of microvascular perfusion were most pronounced in group 2, markedly reduced by University of Wisconsin solution (group 1) and Carolina rinse (group 3) and minimized by combined use of University of Wisconsin solution and Carolina rinse in group 4. Intrahepatic leukocyte-endothelium interaction in sinusoids and postsinusoidal venules was found to depend on the application of Carolina rinse before reperfusion rather than the use of University of Wisconsin solution during cold storage. Activation of phagocytosis by Kupffer cells was most pronounced in group 1, intermediate in groups 2 and 3 and not noticeable in group 4. Hepatocellular excretory function as assessed on the basis of total bile flow and excretion of bile acids during the first 90 min after reperfusion was found to be improved by application of Carolina rinse, both after storage in blood or in University of Wisconsin solution.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of ICAM-1 in chronic hepatic allograft rejection in the rat

“…Since the sole blood supply to the intrahepatic bile ducts is derived from the hepatic artery, an arterialized model is preferable and was employed in the present chronic rejection study. Intrahepatic bile duct loss is predominantly due to direct lymphocytotoxic attack, although ischemia due to obliterative vasculopathy may also be a cofactor in the pathogenesis of bile duct injury (19,22,23). Before a leukocyte can destroy the biliary system, it must 1) migrate out of the bloodstream (a process proven to be highly dependent on ICAM-1) and 2) attach to the bile duct epithelial cells.…”

Cold preservation–warm reperfusion perturbs cytosolic calcium ion homeostasis in rat liver sinusoidal endothelial cells

“…29 In particular, the group at the University of North Carolina has developed a Carolina rinse solution that appears to improve initial graft function. [30][31][32] Our physiological HEPES buffer approximates this condition.…”

Organ Preservation into the 2020s: The Era of Dynamic Intervention

“…Another approach shows that a rinse with the low-potassium solution after cold storage prior to organ implementation substantially diminished postoperative sinusoidal endothelial cell damage. It was concluded that the synergistic action of UW solution as OPS and the Carolina Rinse solution as rinsing vehicle was more beneficial for the vascular bed than each solution used separately [25, 32]. This finding provides some arguments in favor of removal of high-K + -containing solution before transplantation.…”

“…This type of injury is most frequently associated with SCS. Studies of rat liver transplantation demonstrated the crucial role of the onset of blood cessation in the development of IRI, bringing into question early microvascular impairment as a prognostic parameter for the assessment of early graft function in clinical practice [25]. It has been demonstrated that even a short duration of 20 min warm ischemia in the liver results in decreased sinusoidal diameter, which is associated with “plugging” of leukocytes upon reperfusion, as well as sinusoidal obstruction caused by endothelial cell swelling [26].…”