Nachträgliche Revitalisierung hypotherm-ischämisch gelagerter Spenderlebern durch Sauerstoffpersufflation Post-hoc reconditioning of cold stored livers by short term oxygen persufflation

Background: The quality of cold-stored livers slowly declines beyond approximately 12 hours of ischemia and the risk of primary dys- or non-function increases. Previous studies have raised the concept to improve the outcome of marginally preserved organ grafts by post-hoc reconditioning even after extended times of conventional cold storage. Cellular redox status and energy homeostasis could still be favorably influenced immediately prior to transplantation. Here we wanted to demonstrate the potential of postischemic gaseous oxygen persufflation to resuscitate large size liver grafts, unexpectedly subjected to long storage times and to evaluate the optimal treatment interval. Porcine livers were cold stored (CS) at 4 °C for 18 h in HTK solution. Hypothermic reconditioning(HR) was performed in some livers, by insufflation of gaseous oxygen via the caval vein for 1, 2, or 3 hours subsequent to CS. Viability was assessed by controlled reperfusion with autologous blood. HR resulted in a significant 40–50 % reduction of enzyme leakage (AST, LDH) as well as serum levels of TNF-alpha with a maximal effect after 2 hours of HR. Functional parameters (bile production and energetic recovery) were likewise enhanced by the factor 2. HR significantly reduced vascular perfusion resistance of portal vein and hepatic artery compared to CS alone. Trapping of platelets in the reperfused graft, was found to be insignificantly reduced in line with a trend towards lower expression of vWF. These findings show that HR effectively augments viability of long preserved liver grafts in the large animal and suppresses injurious cellular activation cascades upon reperfusion. Two hours of ›a posteriori‹ treatment provide the maximal effect and are recommended for clinical application.