Air embolism during liver procurement: an underestimated phenomenon? A pilot experimental study

Area of Science:

• Transplantation Surgery
• Organ Procurement
• Medical Imaging

Background:

• Intrahepatic air embolism is a risk during liver transplantation, impacting patient outcomes.
• The origin of intrahepatic air during procurement is not well understood.
• This pilot study investigates air entrapment in porcine livers during multiorgan procurement.

Purpose of the Study:

• To quantify air trapped in porcine livers during procurement.
• To determine if avoiding direct air contact with hepatic vasculature reduces air entrapment.
• To assess the impact of air entrapment on liver perfusion.

Main Methods:

• Magnetic resonance imaging (MRI) was used to detect and quantify air bubbles (signal voids).
• Porcine livers were divided into control (standard procurement) and modified (vasculature clamped) groups.
• MRI contrast agent (Gd-DTPA) assessed liver perfusion, with insufficiently perfused areas quantified.

Main Results:

• Control livers had significantly more air bubbles (45 ± 27) than modified livers (6 ± 3).
• Insufficiently perfused liver volume was higher in the control group (28.0%) compared to the modified group (2.6%).
• Avoiding air exposure during procurement substantially reduced air entrapment and improved perfusion.

Conclusions:

• Standard organ procurement and back-table preparation allow significant air entry into the hepatic microcirculation.
• Preventing direct air contact with hepatic vessels during procurement effectively minimizes intrahepatic air embolism.
• This technique shows promise for improving liver graft quality and post-transplant outcomes.