Liver Preservation Techniques for Transplantation

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Abstract
The development of optimal methods for preservation is important for the advancement of liver transplantation. This study compares hypothermic storage (HS) and hypothermic pulsatile perfusion (HPP) with various solutions, using an isolated normothermic perfusion model (LIPM). Canine livers were removed from mongrel dogs without warm ischemia and flushed with either heparinized Ringer's lactate (control and HPP‐preserved groups) or the solution used for hypothermic storage (TP‐V or modified Collins). The type of preservation and solution for each of the experimental groups was as follows: group I (n = 7), no preservation, fresh; group II (n = 7), 24‐h HS with TP‐V (a hyperosmolar colloid solution containing sucrose, dextrose, and ATP‐MgCl2); group III (n = 7), 24‐h HS with modified Collins (C‐2), an intracellular crystalloid solution; group IV (n = 5), 24‐h HP with TP‐V; group V (n = 6), 24‐h HPP with Belzer solution, containing ATP‐MgCl2; group VI (n = 3), 24‐h HPP with albumin. After the preservation period, livers were placed on HPP at 37°C with albumin‐mannitol solution for 3‐h testing in an LIPM. Perfusate samples were taken at 1‐h intervals to assess liver function. LDH, SGOT, alkaline phosphatase, lactic acid, LAP, GGT, pO2, pCO2, pH, osmolarity, AMP, ADP, and ATP were studied. Histologic studies were performed, as were representative HIDA scans. Using the LIPM, livers preserved by HS and HPP with TP‐V solution appeared to be superior to those preserved with modified Collins, Belzer, and albumin solutions. In these non‐TP‐V groups, the greatest cellular and organ damage was observed. TP‐V HPP appeared to give the best overall liver functional response and histologic results and is recommended as the preferred method for 24‐h liver preservation.