LIVERS FROM FASTED RATS ACQUIRE RESISTANCE TO WARM AND COLD ISCHEMIA INJURY

Successful liver transplantation is dependent upon many factors, one o f which is the quality of the donor organ. Previous studies have sugge sted that the donor nutritional status may affect the outcome of liver transplantation and starvation, due to prolonged stay in the intensiv e care unit, may adversely affect the liver. In this study we have use d the orthotopic rat liver transplant model to measure how fasting the donor affects the outcome of liver transplantation. Rat livers were p reserved with UW solution either at 37-degrees-C (warm ischemia for 45 -60 min) or at 4-degrees-C (cold ischemia for 30 or 44 hr). After pres ervation the livers were orthotopically transplanted and survival (for 7 days) was measured, as well as liver functions 6 hr after transplan tation. After 45 min of warm ischemia 50% (3 of 6) animals survived wh en the liver was obtained from a fed donor about 80% (4 of 5) survived when the liver was obtained from a three-day-fasted donor. After 60 m in warm ischemia no animal survived (0 of 8, fed group). However, if t he donor was fasted for 2 days 89% (8 of 9) of the animals survived fo r 7 days. Livers cold-stored for 30 hr were 50% viable (3 of 6) and fa sting for 1-3 days did not affect this outcome. However, if the donor was fasted for 4 days 100% (9 of 9) survival was obtained. After 14-hr preservation only 29% (2/7) of the recipients survived for 7 days. If the donor was fasted for 4 days, survival increased to 83% (5/6). Liv er functions, bile product,ion, and serum enzymes were better in liver s from the fasted rats than from the fed rats. Fasting caused a 95% de crease in liver glycogen content. Even with this low concentration of glycogen, liver viability (animal survival) after warm or cold ischemi a was not affected, and livers with a low glycogen content were fully viable. Thus liver glycogen does not appear to be important in liver p reservation. This study shows that fasting the donor does not cause in jury to the liver after warm or cold ischemia. In fact, the livers app eared to be better able to tolerate ischemia when obtained from fasted rats. Thus donor nutritional status may be an important factor for ou tcome of liver transplantation. Livers from fasted donors may be capab le of tolerating long-term preservation better than livers from fed do nors.