Short-term resuscitation of predamaged donor livers by brief machine perfusion: the influence of temperature.

ABSTRACT

Short-term machine perfusion after liver retrieval from non-heart-beating donors has been considered a beneficial means to reverse deleterious priming of the predamaged organ. In this study, the possible impact of different temperatures during aerobic perfusion was addressed, focusing on liver metabolic functions, structural integrity, and vascular activation. Livers retrieved 30 minutes after cardiac arrest of male Wistar rats (200-300 g) were preserved with histidine-tryptophan-ketoglutarate (HTK) solution for 18 hours by simple cold storage (CS) or subjected to short-term resuscitation (STR) with oxygenated (pO(2) > 500 mm Hg) machine perfusion with HTK at 4 degrees C, 12 degrees C, or 22 degrees C for 2 hours with subsequent CS for 16 hours at 4 degrees C. Upon reperfusion in a normothermic perfusion circuit, STR significantly improved enzyme leakage (alanine aminotransferase, glutamate dehydrogenase) and metabolic recovery (tissue levels of ATP) providing best values at 12 degrees C or 22 degrees C. Moreover, a hugely increased gene expression of the adhesion molecule ICAM-1 as well as major histocompatibility complex (MHC) class II antigen was seen after CS, but significantly alleviated by STR at 4 degrees C or 12 degrees C. However, mRNA for both surface proteins rose significantly after STR at 22 degrees C compared with CS. In conclusion, STR by oxygenated perfusion is beneficial to the predamaged graft, facilitating later transportation and supervision of the graft compared with continuous machine preservation. However, increased perfusion temperature should be recommended only up to the limit of 12 degrees C to prevent overactivation of surface antigen expression.