Orthotopic liver transplantation after preservation without perfusion for up to six hours: A controlled trial evaluating different preservation fluids in dogs and pigs

Abstract

The important extension of the ischemic period recently described with a simple hypothermic liver preservation method is attributed to the use of specific preservation fluids. However, there is no consensus about the optimal preservation fluid. In order to investigate the effect of the composition of the preservation fluid on the immediately postoperative transplant function and on subsequent long-term survival, orthotopic liver transplantations were performed in 13 dogs and 12 pigs. To reduce immunologic interference in postoperative transplant evaluation, donor and recipient pairs always were litter mates, the dogs being identical according to lymphocyte typing. The ischemic periods were 1, 3, and 6 hours. Four different preservation fluids were used with marked differences in ionic composition (extracellular vs. intracellular), pH, and osmolarity. Within each ischemic period group the sequence of experiments was randomized with respect to the different preservation fluids. Twenty-four animals survived the transplantation procedure. No differences were found between the preservation fluid groups. Postoperative function of all livers preserved for 6 hours was comparable to those with 1 hour ischemia. Three dogs and four pigs (six of seven with livers preserved for 3 to 6 hours) are still alive more than 1 year after transplantation. So consistently excellent liver function leading to long-term survival in 36 percent of cases can be obtained after liver transplantation with preservation up to 6 hours; for this result the composition of the preservation fluid is of minor importance.