IMPAIRMENT OF HEPATIC MICROCIRCULATION BY IN-SITU PREPARATION OF THE LIVER BEFORE PERFUSION WITH PRESERVATION SOLUTION

Aim: Usually, in-situ preparation of the hepatic hilar structures is p erformed prior to the perfusion with preservation solution. Aim of thi s study was to investigate mechanical effects of liver preparation on the hepatic microcirculation. Methods: 16 pigs (German landrace) were randomized in two groups. In both groups, laparotomy was performed aft er intratracheal intubation. Subsequently, a thermal diffusion probe w as implanted into the medial left liver lobe for quantification of mic roperfusion. In group A (n=8), bile duct, hepatic artery, and portal v ein were exposed and the lesser omentum transsected thereafter. Ultras ound-volume-probes were placed around the hepatic artery and portal ve in. Simultaneous measurement of hepatic microperfusion and total liver blood how was performed five minutes after the end of liver preparati on. In group B (n=8) hepatic microperfusion was quantified 45 minutes after laparotomy without further manipulations. Results: By the prepar ation, liver perfusion was significantly reduced in group A from 78 +/ - 13 ml/100g/min to 61 +/- 16 ml/100g/min. After preparation a total l iver blood how of 137 +/- 46 ml/100g/min was recorded indicating a shu nt fraction of 51 +/- 21%. In contrast, hepatic microperfusion in grou p B remained at baseline during the whole observation period (79 +/- 3 ml/100g/min vs. 78 +/- 5 ml/100g/ min). Conclusion: In-situ liver pre paration induces a relevant disturbance of hepatic microcirculation. P reservation perfusion shortly after surgical manipulation could become ineffective because of an increase in shunt how If the regeneration p eriod is too short, e.g. lack of heart explantation, the quality of th e liver graft could be limited.