The increasing use of organs for transplantation necessitates the development of optimal preservation techniques. The goal of this study was to investigate changes in elemental content in mouse liver cells during cold storage by x-ray microanalysis in parallel with morphologic studies. Tissue was stored at 4°C for 4 to 12 hours in normal Krebs-Ringer solution (high sodium/potassium ratio), modified Krebs-Ringer solution (low Na+/K+ ratio), Euro-Collins solution, University of Wisconsin (UW) solution, or seven modified versions of the UW solution. Incubation of liver in normal Krebs-Ringer solution caused a significant increase in sodium and decrease in potassium concentrations in contrast to incubation in other solutions. The concentration of sodium, potassium, and chlorine in the cells closely followed the concentration in the storage solution, indicating that the intracellular concentration of these ions during storage is entirely dependent on diffusion processes. The calcium concentration was independent of the storage solution used. Studies by light and transmission electron microscopy showed good preservation of hepatocytes after storage for 8 and 12 hours in UW solution and its variants, modified Krebs-Ringer solution and Euro-Collins solution, but showed moderate damage to mitochondria and swelling of the endoplasmic reticulum in normal Krebs-Ringer solution. In addition, damage to the sinusoidal endothelial cells was observed after 4 hours in normal Krebs-Ringer solution and after 8 to 12 hours in the other solutions. In conclusion, the only factor determining the intracellular concentration of diffusible ions after cold tissue storage is the ionic composition of the extracellular medium. X-ray microanalysis provides an objective method for assessing whether the intracellular ionic composition of tissue is maintained during storage. (Liver Transpl 2003;9:268-278.)