VENOUS AIR-EMBOLISM, PRESERVATION REPERFUSION INJURY, AND THE PRESENCE OF INTRAVASCULAR AIR COLLECTIONS IN HUMAN DONOR LIVERS - A RETROSPECTIVE CLINICAL-STUDY

In human liver transplantation, air embolism is seldom encountered aft er graft reperfusion. Nevertheless, despite adequate flushing and clam ping routines, air emboli have been reported in transesophageal echoca rdiography (TEE) studies performed during the reperfusion phase, We re trospectively investigated whether air in the donor liver - as observe d with pre transplant magnetic resonance imaging (MRI) - resulted in c linical air embolism or contributed to preservation/reperfusion injury , Clinical air embolism was assessed by intraoperative hemodynamics an d end-tidal CO, monitoring. Preservation/reperfusion injury was assess ed in postoperative biochemical measurements. The outcomes were compar ed between patients receiving livers containing significant intrahepat ic air and patients receiving livers without intrahepatic air. Forty-t hree livers were studied, seven of which had major intrahepatic air an d ten of which had no evidence of air collections. Twenty-six livers s howed minor amounts of air and were excluded from further study. One p atient who received a liver that did not contain intrahepatic air had clinical evidence of air embolism. Clinical air embolism did not appea r to be associated with the presence of significant intrahepatic air b ased upon pretransplant MRI. Intrahepatic air did not seem to affect t he amount of preservation/reperfusion injury. Our data indicate that a ir bubbles in the portal and arterial branches are absorbed during rep erfusion and that the majority of intrahepatic air is effectively remo ved by the specific flushing routines.