THE INFLUENCE OF RESUSCITATION ON HEMODYNAMICS AND OXYGEN RADICAL-INDUCED REPERFUSION INJURY AFTER ARTERIALIZED LIVER-TRANSPLANTATION IN THE RAT

Extended hemodynamic monitoring during arterialized rat liver transpla ntation procedure and the effects of resuscitation with albumin, starc h-desferrioxamine-conjugated hydroxyethyl starch (HES-DFO), or hydroxy ethyl starch (HES) on hemodynamics are presented. Livers from SPRD rat s were stored for 20 hr in ice-cold UW solution and were orthotopicall y transplanted with reconstruction of the hepatic artery under hemodyn amical monitoring applying invasive measurement of mean arterial blood pressure (MAP) and cardiac output (GO). Comparable amounts of albumin , HES-DFO, and HES were given in a randomized and blinded fashion afte r transplantation. Ringer's solution was given additionally when blood pressure was below 65 mmHg. Fifteen, 60, and 90 min after surgical pr ocedure blood samples were taken to determine acid base status, blood gases, and blood cell count. Oxygen radical-induced reperfusion injury was determined by thiobarbituric acid reactive substances (TEARS) in serum and total glutathione in liver tissue 90 min after surgery. Duri ng the anhepatic period CO was reduced to 20% of baseline and MAP to 4 0 mmHg. In all groups, declamping led to a transient recovery of hemod ynamic situation, whereas during further reperfusion, CO and MAP were significantly reduced in the HES- and HES-DFO-treated group in contras t to the group receiving albumin. Animals of the HES group required si gnificantly more Ringer's solution to maintain blood pressure (2.6 +/- 0.9 mi; 4 of 6 animals needed additional resuscitation) than animals given albumin (0.4 +/- 0.3 mi, P < 0.05, 2/9 needed further supplement ation) or HES-DFO (1.2 +/- 0.5 mi; 5/10 required additional resuscitat ion), respectively. Animals treated with HES or HES-DFO failed to rest ore base excess and serum lactate in contrast to resuscitation with al bumin. However, TEARS was mitigated by resuscitation with HES-DFO comp ared to albumin and HES, whereas no significant differences were obser ved in respect to tissue glutathione of transplanted livers. In conclu sion the model described allows intensive monitoring of hemodynamic pa rameters and metabolic status during arterialized rat liver transplant ation procedure. Moreover, the results indicate that resuscitation wit h albumin could maintain central hemodynamics and restore homeostasis during the early reperfusion period after transplantation in contrast to resuscitation with HES or HES-DFO, respectively. Although resuscita tion with HES-DFO resulted in mitigation of lipid peroxides determined by TEARS, no significant improvement of hemodynamics and homeostasis could be observed during reperfusion as it can be observed with albumi n. (C) 1996 Academic Press, Inc.