Liver graft preservation: an overview.

BACKGROUND: The quality of liver graft and outcome of liver transplantation is affected by the length of ischemia time during the donor operation. The retrieved graft may have a serious damage during the time of stoppage of the circulation in the donor until revascularization in the recipient. It is very important to develop a suitable preservation fluid to minimise the damage caused by the ischemic period and to make the surgical procedure semi-elective. DATA SOURCES: An English-language literature search was conducted using MEDLINE (1960-2006) on liver preservation solution, liver transplantation, kidney transplantation and other related subjects. RESULTS: Since 1960 until 2006 many preservation solutions have been introduced. Most of them are based on the effect of hypothermia to minimise the metabolic pathway in the liver graft. In the earlier studies electrolyte solutions were used to perfuse the liver through the portal vein. The first modification in preservation solution was done by Collins who was able to extend the kidney preservation time up to 30 hours. In recent years, the introduction of University of Wisconsin (UW) preservation solution has made a revolution in the field of organ preservation. The UW solution is based on lactobionate and raffinose as impermeants to suppress hypothermic-induced tissue swelling, replacing glucose and mannitol in Collin's solution and hypertonic citrate respectively. Recently a research group in Kyoto University works to produce a more reliable preservation solution. They investigated the importance of saccharides and electrolytes in lung preservation and developed their original ET-Kyoto solution. However, more studies are still needed to evaluate the new ET-Kyoto solution. CONCLUSIONS: The development of new preservation solutions represents a corner stone in the field of organ transplantation. In the future we might be able to extend the time of organ preservation from hours to days.

A case of portal vein thrombosis associated with acute cholecystitis/pancreatitis or coincidence.

BACKGROUND: Portal vein thrombosis (PVT) is complex and risk factors include local precipitating factors and acquired and inherited factors. It occurs secondary to abdominal malignancy, infection or surgical intervention. PVT is commonly forgotten as a possible cause of abdominal pain. The clinical picture may vary but abdominal pain and low grade fever are the most characteristic picture. METHODS: A 58-year-old male patient was admitted to our hospital complaining of abdominal pain for three days. CT scan revealed an edematous area around the portal vein. Doppler ultrasonography showed evidence of a portal vein thrombosis. RESULTS: PVT can be diagnosed with CT and Doppler ultrasonography. Fresh thrombus can be undetected by sonography because of the low echogenicity but can be recognized by color Doppler ultrasonography. Treatment ranges from observation and bowel rest to surgical resection of bowel. CONCLUSIONS: When we suspect a case of PVT, it should be treated at an early stage to prevent being lost in a diagnostic dilemma. The immediate use of anticoagulant could be important in preventing serious consequences of PVT.

Donor liver preservation and stimulation of adhesion molecules : cold preservation initiates the cascade.

BACKGROUND: Pro-inflammatory adhesion molecules (including ICAM-1, E-Selectin) are important in clinical hepatic ischaemia and reperfusion injury. The initiating factors remain to be fully elucidated. METHODS: Needle biopsies taken during and after donor liver preservation were studied in 28 cases by immunohistochemical methods. Human responder cell cultures were exposed to the effluent cold storage solution after liver preservation in a further 10 transplants. RESULTS: Increased ICAM-1 staining was seen at the end of cold storage compared to baseline (P less than 0.01), whilst reperfusion caused further increase (P less than 0.001). The storage solutions stimulated ICAM-1 and E-Selectin expression in responder cells in vitro as a bioassay (P less than 0.01 in each case). CONCLUSIONS: Liver harvesting and cold storage can initiate adhesion molecule expression even before reperfusion in the recipient.