A histopathological study of anoxic-resuscitated liver allografts.

The possibility of resuscitating livers after warm ischaemia has been recently suggested. The aim of the present investigation was to analyse the effects of anoxia on the morphology of hepatic cells, to determine whether these effects are reversible after providing a resuscitation period between warm ischaemia (WI) and cooling, and to study the behaviour of the resuscitated liver in the recipient organism. Ten female, Large-White pigs acted as donors for 10 recipient animals of the same kind who received an orthotopic liver graft. Recipients were divided into two groups depending on whether the livers they received had undergone a resuscitation period (Group I (n=5) where animal livers were subjected to 5 min warm ischaemia (WI) without resuscitation, and Group II (n=5) where the livers were subjected to 5 min WI followed by 5 min resuscitation). Morphological and ultrastructural studies of liver cells were performed using light and electron microscopy. ATP, ADP and AMP levels were determined in liver biopsies by high performance liquid chromatography (HPLC). Plasma AST and bilirubin levels in the two groups were compared 24 h after transplantation. After 5 min of anoxia, hepatocytes showed two morphological patterns in response to WI. Some were appreciably condensed with dark mitochondria, peroxisomes and some cytoplasmic vacuoles. Others showed electronlucent organelles, inflamed mitochondria with broken cristae and disorganized endoplasmic reticulum. Hepatocytes showed globular microvilli and bleb formation with migration towards the sinusoids. One hour after the revascularisation of the resuscitated livers, the hepatocytes showed nearly normal morphological characteristics. However, the hepatocytes of non-resuscitated organs continued to show alterations. Kupffer cells were activated in the livers of both experimental groups. Ultrastructural changes and total tissue adenine nucleotide (TAN) levels recovered completely in resuscitated livers soon after transplant. These results suggest that when short WI periods are followed by equivalent periods of resuscitation, the hepatocytes of transplanted livers recover from the effects of anoxia.

Hepatic resuscitation after warm anoxia: one approach for increasing the donor pool for liver transplantation.

The deleterious effects of warm anoxia on the liver are seen to be irreversible if cooling and transplantation (LT) follow immediately after. The aim of our study is to demonstrate that livers subjected to anoxia may be suitable for LT if a period of resuscitation is interposed before the cooling process. Forty female Large White pigs were used. Preservation (Euro-Collins solution) and LT technique were the same in all 20 procedures. All donors underwent clamping of the porta hepatis at the end of harvesting dissection. In the so-called "resuscitated" groups (AR and BR), the clamp was released for a period of time before the liver was cooled. Then, all livers underwent 2 h of cold ischemia followed by LT. Ultrastructural study showed better maintenance of mitochondria and sinusoidal cell integrity in resuscitated livers after LT. Liver synthesis of total adenine nucleotides, graft function and recipient survival were found to be better in the "resuscitated" groups. In conclusion, anoxic livers may be retrieved for LT if a resuscitation period (i.e. aerobic perfusion) is allowed prior to cold preservation. Longer periods of warm anoxia are needed to further support these preliminary results.

Preservation of the recipient inferior vena cava in liver transplantation.

Twenty piggy-back (PB) liver transplantations (LT) were compared with 20 LT performed by the standard technique in order to evaluate whether or not the theoretical haemodynamic advantages of the preservation of the inferior vena cava (IVC) have any impact on the final results of the LT. Statistically significant differences were observed in the duration of the hepatectomy, which was longer for PB LT (192 min vs. 146 min), and in the duration of the anhepatic phase, which was shorter in that group (52 min vs. 76 min). There were no differences in the duration of the complete surgical procedure, consumption of blood products, incidence of postoperative acute renal failure, number of reoperations or survival.

The impact of the different severe infections on the outcome of liver transplantation. A study of 150 patients.

Severe infection (Sev Inf) is still the main cause of morbidity and mortality after liver transplantation (LTx). The aim of our study was to analyze how each type of infection, bacterial, fungal or viral, influences the rates of morbidity and mortality after LTx.

Results after liver retransplantation in a group of 50 regrafted patients: two different concepts of elective versus emergency retransplantation.

Liver retransplantation remains the only alternative therapy for irreversible graft failure. Previous studies have demonstrated lower survival rates for liver retransplantation than for primary grafts. After reviewing our clinical experience with 55 retransplantations out of 365 liver transplants, we found that the risk and results depend on the surrounding circumstances. Elective retransplantation was shown to be as safe as the first liver transplantation, while emergency retransplantation yielded significantly higher morbidity and mortality rates.

Bile acid profile as early indicator of allograft function during orthotopic liver transplantation.

Orthotopic liver transplantation was performed in 20 pigs. Serum total bile acids (STBA) were determined and their profile compared with standard early function parameters: total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactic acid. In phase I, the STBA level was 32.89 +/- 1.29 mumol/l. In phase II, STBA accumulated to 84.46 +/- 15.25 mumol/l (p less than 0.01), followed by hepatic clearance in phase III (63.61 +/- 9.71 mumol/1; NS). Between phase III and 6- and 12-hour samples, STBA decreased progressively, reaching values of 33.63 +/- 7.05 mumol/l at 24 h. AST was elevated in phases I, II, III, and at 6, 12 and 24 h (p less than 0.001), as was ALT (but with insignificant differences). Thus, STBA and their profile appear to be earlier and more specific indicators of early graft function than conventional parameters.