1997 Abstract: 146 Cold ischemia of more than 10 hours reduces graft quality in clinical liver transplantation.
Abstracts 1997 Digestive Disease Week
Cold ischemia of more than 10 hours reduces graft quality in
clinical liver transplantation.
E Klar, M Angelescu, Th Kraus, M Bredt, A Mehrabi, G Otto, C Herfarth.
Department of Surgery, University of Heidelberg, Heidelberg, Germany.
As previously demonstrated intraoperative liver perfusion below 60
ml/100g/min is associated with poor liver function and primary graft failure
after transplantation. Cold ischemia time is generally accepted as a determinant
of graft quality. It was the aim of this prospective study to define the maximum
duration of cold ischemia beyond which a reduction of graft quality can be
detected concerning critical impairment of hepatic microcirculation, increase of
AST, and extent of postoperative fresh-frozen-plasma (FFP) substitution.
Methods: In 33 patients a thermodiffusion probe was placed into segment IV
during orthotopic liver transplantation. Liver perfusion was quantified
intraoperatively 60 min after reperfusion. As indicators of graft function the
maximum increase of serum AST (ASTmax) and the amount of
FFP-administration was recorded postoperatively. By these parameters graft
quality was compared within vs. beyond certain ischemia time intervals ranging
from 8 to 15 hours (60-min steps) using Fisher's exact test or Mann-Whitney
U-Test. The aim was to define the maximum length of ischemia time without
significant difference.
Results: A negative correlation was detected between the duration of cold
ischemia and intraoperative liver perfusion (r=0.57, p<0.001, Spearman rank
correlation). Up to a cold ischemia time of 10 hrs. no patient was recorded with
a hepatic perfusion below the the critical value of 60 ml/100g/min. Cold
ischemia of more than 10 hours resulted in a significant impairment of hepatic
microcirculation (Fisher's exact test, p<0.01) as well as in a significant
increase in the number of patients with ASTmax above 1000 U/L (p<0.05)
or postoperative requirement of FFP-substitution (p<0.01).
Conclusion: Hepatic microcirculation as one main determinant of graft
quality is significantly influenced by the duration of cold ischemia. However,
up to a cold storage time of 10 hours graft function is not significantly
reduced with respect to the critical range of hepatic perfusion, maximum
postoperative serum AST, or the necessity of FFP-administration.
