Adding Pulsatile Vascular Stimulation to Venous Systemic Oxygen Persufflation of Liver Grafts
Bastian Lüer
Surgical Research Division, University Clinic of Surgery, Bonn, Germany
Search for more papers by this authorMario Fox
Surgical Research Division, University Clinic of Surgery, Bonn, Germany
Search for more papers by this authorPatrik Efferz
Surgical Research Division, University Clinic of Surgery, Bonn, Germany
Search for more papers by this authorCorresponding Author
Thomas Minor
Surgical Research Division, University Clinic of Surgery, Bonn, Germany
Address correspondence and reprint requests to Prof. Thomas Minor, Surgical Research Division, University Clinic of Surgery, 53127 Bonn, Germany. E-mail: [email protected]Search for more papers by this authorBastian Lüer
Surgical Research Division, University Clinic of Surgery, Bonn, Germany
Search for more papers by this authorMario Fox
Surgical Research Division, University Clinic of Surgery, Bonn, Germany
Search for more papers by this authorPatrik Efferz
Surgical Research Division, University Clinic of Surgery, Bonn, Germany
Search for more papers by this authorCorresponding Author
Thomas Minor
Surgical Research Division, University Clinic of Surgery, Bonn, Germany
Address correspondence and reprint requests to Prof. Thomas Minor, Surgical Research Division, University Clinic of Surgery, 53127 Bonn, Germany. E-mail: [email protected]Search for more papers by this authorAbstract
The effect of adding pulsatility to gaseous oxygen persufflation during liver preservation was studied in an isolated rat liver model. Livers from male Wistar rats were retrieved 30 min after cardiac arrest of the donor and subjected to 18 h of cold storage. Some grafts were subjected to nonpulsatile or pulsatile gaseous oxygen persufflation. Graft viability was assessed thereafter upon warm reperfusion in vitro (n = 5 per group). Pulsatile persufflation significantly improved parenchymal integrity (enzyme release, bile flow) upon reperfusion, with respect to nonpulsatile persufflation or cold storage (CS) (e.g., max. release of alanine aminotransferase: 44 ± 10 vs. 178 ± 29 vs. 345 ± 100 U/L; pulsatile vs. nonpulsatile persufflation vs. CS).The effect was associated with the prevention of the ischemic decline in gene and protein expression of the vasoprotective Krüppel-like factor 2, increased perfusate levels of the endogenous vasodilator nitric oxide, and reduced portal vascular resistance upon reperfusion, while nonpulsatile persufflation was less effective (e.g., vascular resistance: 1235 ± 108 vs. 1607 ± 155 vs. 2215 ± 208 Pa s/mL; pulsatile vs. nonpulsatile persufflation vs. CS). In conclusion, pulsatile mechanostimulation of the hepatovasculature seems a genuine protective mechanism, affecting early graft recovery upon reperfusion.
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