Reduction of rewarming injury of the hepatic graft by a heat insulator.

Abstract

The deleterious effect of rewarming in orthotopic liver transplantation is recognized. This study examined the significance of rewarming the hepatic allograft, and the possibility of using a heat insulator to reduce rewarming injury. After total hepatectomy in rats with in situ perfusion by chilled (4 degrees C) lactated Ringer's solution, the livers were divided into four groups of ten each: group 1, 4-h preservation in chilled Ringer's solution and 15 min of rewarming; group 2, 6-h preservation in chilled Ringer's solution; group 3, 6-h preservation in chilled Ringer's solution and 15 min of rewarming; group 4, 6-h preservation in chilled Ringer's solution and 15 min of rewarming with a heat insulator. Glutamic-pyruvic transaminase (GPT) and N-acetyl-beta-glucosaminidase (NAG) concentrations in the final graft effluent, and the amount of adenosine 5'-triphosphate (ATP) in liver tissue after preservation, were measured. GPT and NAG concentrations in the final graft effluent of group 3 were higher than those of group 2 (P < 0.01), whereas values in group 4 were lower than those of group 3 (P < 0.05). The final ATP concentration in group 3 was significantly lower than that in group 2 (P < 0.01), whereas the value in group 4 was significantly higher than that of group 3 (P < 0.01). Rewarming diminishes the viability of a liver graft with degradation of ATP, and a heat insulator reduces rewarming injury.