Initial Blood Washout During Organ Procurement Determines Liver Injury and Function After Preservation and Reperfusion

Abstract

Organ procurement is the first step toward effective liver preservation and comprises a thorough washout of blood components from the microvasculature. To study the efficacy of optimal blood washout of the liver, three groups were compared including low-pressure perfusion with UW-CSS (12 mmHg, group A), which is the routine method in clinical practice, high-pressure perfusion with UW-CSS (100 mmHg, group B) and low-pressure perfusion with modified UW solution (12 mmHg, group C). After procurement all livers were preserved in original UW-CSS for 0, 24 or 48 h, followed by reperfusion in oxygenated Williams Medium E for 24 h at 37• C. Histology results of livers procured in group A, showed good hepatocyte viability but also remaining erythrocytes. However, injury parameters were high and ATP concentrations were low. No functional differences were found. Group B, high pressure, and group C, modified UW-CSS, both showed better results. High-pressure washout is preferable since the warm ischemia time during procurement is short. We propose to use high-pressure UW-CSS perfusion for the initial blood washout of the donor liver instead of the usually used low-pressure washout.

Using HTK for Prolonged Pancreas Preservation Prior to Human Islet Isolation

“…As demonstrated in rat livers, the high viscosity of UWS and its content of hydoxyethyl starch require a high perfusion pressure and can result in nonhomogenous fluid distribution, which hampers effective organ clearance from blood [29,30]. Moreover, the specific composition and high viscosity of UWS can result in harmful formation of adenosine crystals during cold shelf storage.…”

Improving Research Practice in Rat Orthotopic and Partial Orthotopic Liver Transplantation: A Review, Recommendation, and Publication Guide

“…the removal of blood components from the microvasculature during liver retrieval, may affect subsequent graft injury and function [76,77]. Numerous parameters related to graft washout in transplantation settings might influence its efficacy in removing blood cells: (1) type of solution (colloid content, viscosity) [78]; (2) temperature (hypothermic or normothermic washout) [79]; (3) high or low washout pressure/speed (shear stress) [76,80,81]; (4) washout time [77]; (5) heparinization [82,83], and (6) way of washout (portal venous, arterial, or simultaneous) [77]. …”

Perspectives in Organ Preservation

“…Analyzing the effect of HES on red blood cells (RBCs), several authors have shown an increased RBC aggregability in both human and rat whole blood when large molecular sized HES is present (30,32). This effect could partially explain the frequently slower washout of blood and initially patchy reperfusion of organs when UW-CSS is used in clinical practice (33).…”