Effect of extended cold ischemia time on glucose metabolism in liver grafts: experimental study in pigs

Recovery of normal carbohydrate metabolism in the liver after transplantation is highly important. The aim of the present study was to evaluate how short and long cold ischemia (CI) time followed by warm ischemia (WI) impact intrahepatic glucose metabolism in a pig liver transplantation model.

Twenty-six animals were divided into two transplantation groups: group I with a liver ischemia time of 5 h (n = 6), and group II with 15 h of liver ischemia (n = 7). Intrahepatic microdialysis samples were collected throughout the experiment at 20-min intervals, during the donor operation, cold preservation, liver implantation, and liver reperfusion in the recipient. Glucose, lactate, and pyruvate concentrations were analyzed and the lactate/pyruvate ratio (L/Pr) was calculated.

There were no changes in glucose levels during CI. However, during WI, glucose and lactate increased and the increase was significantly higher in the group with longer CI (P < 0.01). The L/Pr increased at the beginning of CI but accelerated to increase during WI in both groups, with significantly prolonged and higher levels in the group with longer CI (P < 0.01).

Extended CI results in increased intrahepatic glycogenolysis, delayed restoration of aerobic glycolysis, and prolonged anaerobic glycolysis shortly after reperfusion. Improvements in glycogen protection and faster restoration of aerobic metabolism during preservation and reperfusion time seem to be necessary in order to improve liver preservation protocols per se.