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Liver protection by hypothermic perfusion at different temperatures during total vascular exclusion


T.M. van Gulik, MD, Department of Surgery (Surgical Laboratory), Academic Medical Center, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
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Abstract: Introduction: Insitu hypothermic perfusion (HP) can be applied to attenuate ischemia and reperfusion (I/R) injury during liver resection under total vascular exclusion (TVE). This study examines the protective effect of cooling by HP at 20 and 28°C as compared with no HP during TVE in a porcine liver I/R model.

Methods: Twenty-one pigs underwent 60 min TVE of the liver followed by 24 h reperfusion. HP was performed via the portal vein using ringerlactate solution of 4°C. Pigs were assigned to three groups: TVE without HP (no-HP, n=9), TVE with HP at 28°C (HP-28, n=6) and TVE with HP at 20°C (HP-20, n=6).

Results: Perfusion volumes during TVE were 5.1±0.5 and 17.3±1.7 l in HP-28 and HP-20, respectively (P<0.05). Aspartate aminotransferase (AST) after 24 h reperfusion was 1172±440 U/l in no-HP as compared with 223±69 and 180±22 U/l in HP-28 and HP-20, respectively (P<0.05). No differences in liver function or histopathology were found between the HP-28 and HP-20 groups.

Conclusions: HP at 20°C is equally effective in preserving liver function and preventing hepatocellular injury under TVE as compared with HP at 28°C. HP at 28°C is advised, because of the lesser perfusion volume necessary for cooling of the liver.