Tolerance of the Human Liver to Prolonged Normothermic Ischemia

Huguet, C

doi:10.1001/archsurg.1978.01370240070012

Cited by 158 publications

(41 citation statements)

References 6 publications

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“…These results confirm that the liver may tolerate different periods of CA [1,2], but at the same time, the duration of the WIT has a deleterious effect on the viability of a potential graft. Recently, Takada et al [10] were able to obtain survival after 60 min of WIT confirming the same hypothesis.…”

Section: Survival and Liver Viabilitysupporting

confidence: 68%

“…Although it has been shown that the liver may tolerate long periods of warm ischemia relatively well [1,2], clinical experience with donor livers from non-heart-beating donors (NHBD) has been limited up to now [3], and usually poor results have been obtained [4]. The main problem in order to be able to use such livers in clinical transplantation is related to the necessity for the immediate capacity of the graft to sustain life.…”

Section: Introductionmentioning

confidence: 99%

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

García‐Valdecasas¹,

Tabet²,

Valero³

et al. 1999

Eur Surg Res

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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.

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Section: Survival and Liver Viabilitysupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

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

García‐Valdecasas¹,

Tabet²,

Valero³

et al. 1999

Eur Surg Res

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“…This is mainly due to the lack of knowledge about the reversibility of histological damage and the fact that immediate liver function remains unpredictable after transplantation [37]. Despite such limited and sometimes poor experience, clinical and experimental reports suggest that the liver can tolerate a substantial period of warm ischemia, even periods up to 60 rnin [16,23,32,33,35].…”

Section: Introductionmentioning

confidence: 99%

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

García-Vaidecasas¹,

Tabet²,

Valero

et al. 1998

Transplant Int

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Preliminary results of this study were presented at the XVI World Congress of the Transplantation Society, Barcelona, Spain, August 1996 J. C. Garcia Abstract The aim of this study was to compare the possible role of normothermic recirculation with the role of liver transplants from nonheart-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 rnin of cardiopulmonary bypass and tissue oxygenation at 37 "C before total body cooling. Survival at 5 days; endothelial (hyaluronic acid) and hepatocellular damage (AST, ALT, and a-GST); adenine nucleotides (energy charge), and histological changes were evaluated. Normothermic recirculation during 30 rnin 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 rnin 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.

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“…Interestingly, warm ischemia is much better tolerated in the pig. Survival after 6 h has been reported [24], while in humans, the limit is about 90 min [21,22]. A relationship between the duration of warm ischemia and primary dysfunction has been welldocumented.…”

Section: Discussionmentioning

confidence: 99%

Tauroursodeoxycholate ameliorates reperfusion injury after pig liver transplantation

et al. 1999

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Reperfusion injury is a serious problem after clinical liver transplantation, often leading to dys-or even non-function of grafts. The present study was designed to determine whether the hydrophilic bile salt tauroursodeoxycholate (TUDC), known to be hepatoprotective in cholestatic liver disease, mitigates reperfusion injury in an in vivo pig liver transplantation model. Liver transplantation was performed in 12 pigs after a preservation time of 8 h. TUDC was administered to donor and recipient animals, and saline to controls. Blood was drawn at different time points for determination of liver enzymes. Bile samples were collected, and bile flow (BF), and bile salt secretion rate (BSSR) determined. Samples of liver tissue and bile ducts were taken for assessment by light and electron microscopy. Liver enzymes were significantly lower in the TUDC group. BF and BSSR were significantly higher. Microscopy revealed better preservation of bile duct architecture of the TUDCinfused animals. We can conclude that infusions of TUDC in pig livers ameliorate reperfusion injury in vivo. The molecular basis for this finding may be the membrane stabilizing effect of TUDC. Further studies are warranted to clarify its effect.

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Tolerance of the Human Liver to Prolonged Normothermic Ischemia

Cited by 158 publications

References 6 publications

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

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

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

Tauroursodeoxycholate ameliorates reperfusion injury after pig liver transplantation

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