Effect of warm ischemia time and organ perfusion technique on liver microvascular preservation in a non-heart-beating rat model

Background Current organ shortage has led to a reconsideration of non-heart -beating cadaveric donation. Methods. We assessed the effectivity of dual, i.e., arterial and portal-ven ous versus exclusive, arterial gravity perfusion for procurement of rat liv ers after 30 min and 60 min of cardiac arrest, analyzing the rate and homog eneity of microvascular perfusion by in situ fluorescence microscopy, Results. After 30 min of cardiac arrest, a nearly 100% recovery of acinar p erfusion with a sinusoidal density not significantly different from that, o f normal, nonischemic livers was achieved by dual gravity perfusion. Prolon gation of cardiac arrest: to 60 ruin caused an almost 50% deficit of acinar and sinusoidal perfusion (P<0.05) with a concomitant 2-3-fold increase of heterogeneity of hepatic microperfusion, Regardless of the warm ischemic ti me period, dually perfused livers exhibited significantly (P<0.05) higher r ates of both acinar and sinusoidal perfusion with increased homogeneity of microcirculation when compared with exclusive arterial perfusion, Conclusion, These data underline the need and benefit of dual perfusion as well as the limitation of warm ischemic tolerance to 30 min for safe liver procurement of non-heart beating donors.