Hepatic resuscitation after warm anoxia: one approach for increasing the donor pool for liver transplantation

The deleterious effects of warm anoxia on the liver are seen to be irreversible if cooling and transplantation (LT) follow immediately after. The aim of our study is to demonstrate that livers subjected to anoxia may be suitable for LT if a period of resuscitation is interposed before the cooling process. Forty female Large White pigs were used. Preservation (Euro-Collins solution) and LT technique were the same in all 20 procedures. All donors underwent clamping of the porta hepatis at the end of harvesting dissection. In the so-called "resuscitated" groups (AR and BR), the clamp was released for a period of time before the liver was cooled. Then, all livers underwent 2 h of cold ischemia followed by LT. Ultrastructural study showed better maintenance of mitochondria and sinusoidal cell integrity in resuscitated livers after LT. Liver synthesis of total adenine nucleotides, graft function and recipient survival were found to be better in the "resuscitated" groups. In conclusion, anoxic livers may be retrieved for LT if a resuscitation period (i.e. aerobic perfusion) is allowed prior to cold preservation. Longer periods of warm anoxia are needed to further support these preliminary results.