Effect of early arterialization of the porcine liver allograft on reperfusion injury, hepatocellular injury, and endothelial cell dysfunction

Abstract

The conventional technique of liver transplantation involves the initial perfusion of the graft with portal blood. However, recent evidence suggests that initial arterialization of the graft may be better. The aim of this study is to evaluate the timing of arterialization on reperfusion injury, hepatocellular injury, and endothelial cell function after liver transplantation. Large white X Landrace pigs (n ‫؍‬ 24) were subjected to orthotopic liver transplantation. The animals were randomly assigned to 4 groups, ranging from late arterialization (60 minutes after portal reperfusion) to early rearterialization (20 minutes before portal reperfusion). Aspartate aminotransferase levels continued to increase 4 hours posttransplantation in group 1 (late arterialization), but remained stable after 1 hour posttransplantation in group 4 (early rearterialization). Levels of malondialdehyde doubled in all groups after portal reperfusion with the exception of group 4, in which the liver received arterial blood before portal reperfusion. Vitamin A levels decreased in all groups after revascularization, but the decrease was more pronounced and prolonged in groups 1 and 2 (late arterialization) compared with groups 3 and 4 (early rearterialization). Hyaluronic acid levels continued to increase in all groups until 1 hour posttransplantation except in group 4, in which the level decreased from 20 minutes posttransplantation. Results of this study show that early rearterialization is associated with less hepatocellular damage, less reperfusion injury, and improved liver endothelial cell function. In conclusion, our results indicate that early rearterialization of the graft is beneficial to the transplanted liver. (Liver Transpl 2001;7:32-37.)

Sequence of reperfusion influences ischemia/reperfusion injury and primary graft function following porcine liver transplantation

“…Investigating primary arterial reperfusion experimental and clinical results showed beneficial effects for this method 18, 21–23. This beneficial effect could not be demonstrated in the presented study.…”

“…In experimental studies simultaneous reperfusion showed better microcirculatory perfusion patterns 7. Early arterialization including simultaneous reperfusion was associated with a lower serum aminotransferase peak and a better endothelial function 18. Physiological, simultaneous reperfusion in liver transplantation might provide some potential advantages.…”

The sequence of revascularization in liver transplantation: It does make a difference

“…Various reperfusion protocols have been analyzed in 3 experimental studies, using different animal models 1–3. Hickman and Innes1 compared 2 sequential protocols in pigs: initial arterial revascularization (IAR) vs. initial portal revascularization (IPR).…”

“…However, there were no differences in posttransplantation aspartate aminotransferase serum levels among the 2 groups. van As et al2 analyzed 3 different sequences of graft reperfusion in a pig model: IAR, IPR, and simultaneous portal and arterial revascularization. In their study, IAR was associated with less hepatocellular reperfusion injury and better endothelial cell function, when compared to IPR or simultaneous reperfusion.…”

Use of a branch patch with the cystic artery in living‐related liver transplantation

“…Our method of arterial reconstruction allows us to reduce the time of arterial revascularizazion of the graft, up to 5-8 min. Early arterial vascularization (12,13) is important for early graft reperfusion and microsurgical technique is a time consuming procedure requiring a reported average reconstruction time of 45-50 min (3).…”