Does oxygen supply improve graft viability in liver preservation?

Abstract

While the clinical results of orthotopic liver transplantation have greatly improved, the viability of liver grafts and extension of the safe time for preservation are necessary factors in need of improvement. The liver is one of the organs most sensitive to anoxia. The addition of an oxygen carrying agent to the preservation solution was evaluated. Pyridoxalated hemoglobin-polyoxyethylene conjugate (PHP) is used as an oxygen carrier. Viaspan (UW) served as a control solution. Test solution (PHP+UW) composition was composed of a 1:1 mixture of PHP and UW solutions with hemoglobin 4.0g%, hydroxyethyl starch 2.5g%, osmolality 320 mOsm/kg H2O, and colloidal osmotic pressure 33 mmHg. The oxygen carrying capacity of PHP+UW solution is about 10 times higher than UW solution at 4 degrees C. Male Lewis rats (BW: 250-300 g) were divided into five groups. After flushing the solution via the portal vein, rat livers were harvested. Two preservation methods, simple storage and perfusion (0.1 ml/min/g liver), were studied at 4 degrees C for 24 or 48 hours. OxyHb, MetHb, pO2, pH, Na, K, GOT, and GPT of perfusate, hepatic mitochondrial functions after preservation, and tissue adenine nucleotides by HPLC were measured. Light microscopy on the tissue was also performed. No significant differences were noted in perfusate biochemical parameters. Oxygen consumption during the perfusion was significantly higher in the PHP+UW than in the UW group. Hepatic mitochondrial functions and tissue ATP levels were better preserved in perfusion than in simple storage, and in PHP+UW than in UW at 48 hours. The oxygen carrying agent, PHP, can provide significantly higher levels of oxygen to liver grafts and improve graft viability.