Protection of liver ischemia due to inflow occlusion using prior perfusion with hepatic protective solution in dogs

Temporary occlusion of hepatic inflow is a useful maneuver to reduce hemorrhage from liver trauma and difficult hepatic resections. The liver can be protected with a hepatic protective solution before inflow occlusion, just as the stopped heart is protected by a cardioplegic solution during open heart surgery. Twenty dogs were divided into two groups. The portal inflow of group A was infused via the mesenteric venous branch with a hepatic protective solution composed of 250 mg of hydrocortisone, 15 mEq of KC1, 6 mL of 0.1 N HC1, 5 mL of 10% magnesium sulfate and 250 mg of dextrose in one liter of cold lactated Ringer's solution. Group B was infused with cold lactated Ringer's solution as a control. The hepatic artery and portal vein were isolated and then clamped for 30 minutes. The elevation of serum GOT and GPT after release of the clamps was significantly greater in group B, especially during the first 48 hours. The levels of alkaline phosphatase and total bilirubin were also higher in group B until the 7th day. The results liver biopsies 3 hours after release of the clamps revealed marked congestion and destruction of hepatocytes in group B. We conclude that liver perfusion with a hepatic protective solution before inflow occlusion results in less damage to liver tissue and less impairment of liver function. Such protection is important in liver surgery.