Evaluation of ischemic injury during liver procurement from non-heart-beating donors

The aim of this study was to assess liver viability after different periods of cardiac arrest and the predictive value of two markers of ischemia-repe rfusion injury. Methods: A pig liver transplantation model of non-heart-bea ting donors was studied. Four donor groups were designed; three groups were submitted to different periods of cardiac arrest (20, 30 and 40 min), and the fourth group served as the control group (without cardiac arrest). In t he non-heart-beating donor groups, normothermic recirculation was establish ed 30 min prior to total body cooling. Aminotransferase, alpha-glutathione- S-transferase, and hyaluronic acid determinations as well as liver biopsies , were serially performed. Results: Although hepatocellular function could be preserved after 40 min of cardiac arrest, histological lesions at 5 days were considered irreversible due to the presence of a necrotic biliary tra ct. An overall significant relationship was found between the time period o f cardiac arrest (20, 30 or 40 min) and the levels of hyaluronic acid (p = 0.004) or alpha-glutathione-S-transferase (p = 0.01) obtained during liver procurement and transplantation. Conclusions: The period of cardiac arrest is the determinant factor of liver viability after liver transplantation fr om non-heart-beating donors. As early markers of endothelial or hepatocellu lar damage, hyaluronic acid or alpha-glutathione-S-transferase levels may h elp to evaluate the ischemic injury of a potential donor. Copyright (C) 199 9 S. Karger AG, Basel.