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Study of rat liver transplantation from non-heartbeating cadaver donors
1Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
Background:
The aim of this study was to determine if livers could tolerate prolonged warm ischemia and to determine optimum timing of intervention in the cadaver donor to preserve liver viability. Livers harvested from non-heartbeating donors (NHBDs) would greatly expand the donor pool for transplantation. However, sensitivity of the donor liver to warm ischemia is a major obstacle for successful use of livers from NHBDs. The limit of non-heartbeating time in the donor remains unknown.
Study Design:
Hepatic transplantation was performed in ten groups of rats with stepwise increase of cardiac arrest time in the donor from zero to 180 minutes with 20-minute intervals. The cardiac arrest time was counted from ligation of the base of the donor's heart to the beginning of cold flushing of the liver. Bile flow, bile acid outputs, hepatic functions, and rat survival rates in each group were compared.
Results:
Survival rates from groups 1 to 10 were 83.3, 100, 83.3, 50, 66.7, 50, 16.7, 16.7, zero, and zero percent, respectively. The stepwise increase of non-heartbeating time significantly reduced recipient survival rates after 100 minutes. In addition, the increase caused a stepwise decrease of bile flow rates and bile salt outputs and an increase of serum aspartate aminotransferase and lactate dehydrogenase activities.
Conclusions:
The liver is less sensitive to warm ischemia than formerly believed. Rat livers can be used for transplantation after cardiac arrest up to 140 minutes with a chance of survival.