Evaluation of Ischemic Injury during Liver Procurement from Non-Heart-Beating Donors

Abstract

The aim of this study was to assess liver viability after different periods of cardiac arrest and the predictive value of two markers of ischemia-reperfusion injury. Methods: A pig liver transplantation model of non-heart-beating donors was studied. Four donor groups were designed; three groups were submitted to different periods of cardiac arrest (20, 30 and 40 min), and the fourth group served as the control group (without cardiac arrest). In the non-heart-beating donor groups, normothermic recirculation was established 30 min prior to total body cooling. Aminotransferase, α-glutathione-S-transferase, and hyaluronic acid determinations as well as liver biopsies, were serially performed. Results: Although hepatocellular function could be preserved after 40 min of cardiac arrest, histological lesions at 5 days were considered irreversible due to the presence of a necrotic biliary tract. An overall significant relationship was found between the time period of cardiac arrest (20, 30 or 40 min) and the levels of hyaluronic acid (p = 0.004) or α-glutathione-S-transferase (p = 0.01) obtained during liver procurement and transplantation. Conclusions: The period of cardiac arrest is the determinant factor of liver viability after liver transplantation from non-heart-beating donors. As early markers of endothelial or hepatocellular damage, hyaluronic acid or α-glutathione-S-transferase levels may help to evaluate the ischemic injury of a potential donor.

Biliary cast syndrome following liver transplantation: Predictive factors and clinical outcomes

“…Prolonged warm ischemic time has also been associated with irreversible bile duct damage and poorer outcomes in NHBD grafts. [17][18][19] With respect to postoperative issues, there was no significant difference in the length of postoperative hospital stay, immunosuppressive regimen, number of acute or chronic cellular rejection episodes, or development of hepatic artery stenosis noted between patients with BCS and controls. However, the number of repeat hospital admissions after BCS diagnosis and the number of required biliary therapeutic procedures were significantly greater in BCS patients compared to controls.…”

Segmental Liver Transplantation from Non-Heart Beating Donors—An Early Experience with Implications for the Future

“…The combination of warm and cold ischemia in NHBDs appears to make these grafts more susceptible to biliary complications. A higher incidence of ischemic cholangiopathy has been reported (7,8). D'Alessandro also recognized an increased incidence of ischemic biliary complications in NHBD liver graft recipients from donors older than 40 years of age (9).…”

Step-by-Step Guide for a Simplified Model of Porcine Orthotopic Liver Transplant

“…Since the mid 1990s, our group has used a simplified technique to perform hundreds of liver transplants in pigs with consistent success [15][16][17][18][19][20]. The purpose of this work is to communicate, in detail, how to reproduce this technically straightforward model, from the induction of anesthesia to the postoperative follow-up.…”