Liver conditioning after cardiac arrest: the use of normothermic recirculation in an experimental animal model

The aim of this study was to compare the possible role of normothermic reci rculation with the role of liver transplants from nonheart-beating donor pi gs after 20 min of cardiac arrest. Three groups were studied, of which two were control groups: group 1, in which the liver was harvested from a heart -beating donor; group 2, in which the liver was harvested after a period of cardiac arrest followed by total body cooling; and group 3, in which the l iver was procured as in group 2, but including a period of 30 min of cardio pulmonary bypass and tissue oxygenation at 37 degrees C before total body c ooling. Survival at 5 days; endothelial (hyaluronic acid) and hepatocellula r damage (AST, ALT, and cr-GST); adenine nucleotides (energy charge), and h istological changes were evaluated. Normothermic recirculation during 30 mi n showed a significant effect on survival (p =.03), endothelial damage (p < .05), and histological changes after reperfusion (p =.04). Cardiopulmonary bypass significantly increased the energy charge during the normothermic re circulation period (p =.001). Moreover, this study shows that a significant survival (100 %) can be achieved with a liver allograft after 20 min of ca rdiac arrest. Although the liver suffers a major insult in terms of endothe lial damage and hepatocellular damage, lesions caused by the ischemic injur y are reversible. Histological changes also indicate lesion reversibility, since they almost disappear after 5 days.