REDUCTION OF REWARMING INJURY OF THE HEPATIC GRAFT BY A HEAT INSULATOR

Background The deleterious effect of rewarming in orthotopic liver tra nsplantation is recognized. This study examined the significance of re warming the hepatic allograft, and the possibility of using a heat ins ulator to reduce rewarming injury. Methods After total hepatectomy in rats with in situ perfusion by chilled (4 degrees C) lactated Ringer's solution, the livers were divided into four groups of ten each: group 1, 4-h preservation in chilled Ringer's solution and 15 min of rewarm ing; group 2, 6-h preservation in chilled Ringer's solution; group 3, 6-h preservation in chilled Ringer's solution and 15 min of rewarming; group 4, 6-h preservation in chilled Ringer's solution and 15 min of rewarming with a heat insulator. Glutamic-pyruvic transaminase (GPT) a nd N-acetyl-beta-glucosaminidase (NAG) concentrations in the final gra ft effluent, and the amount of adenosine 5'-triphosphate (ATP) in live r tissue after preservation, were measured. Results GPT and NAG concen trations in the final graft effluent of group 3 were higher than those of group 2 (P < 0.01), whereas values in group 4 were lower than thos e of group 3 (P < 0.05). The final ATP concentration in group 3 was si gnificantly lower than that in group 2 (P < 0.01), whereas the value i n group 3 was significantly higher than that of group 3 (P < 0.01). Co nclusion Rewarming diminishes the viability of a liver graft with degr adation of ATP, and a heat insulator reduces rewarming injury.