L-arginine reduces liver and biliary tract damage after liver transplantation from non-heart-beating donor pigs

Background. To evaluate whether L-arginine reduces liver and biliary tract damage after transplantation from non heart-beating donor pigs. Methods. Twenty-five animals received an allograft hom non-heart-beating do nors, After 40 min of cardiac arrest, normothermic recirculation was run fo r 30 min. The animals were randomly treated with L-arginine (400 mg kg(-1) during normothermic recirculation) or saline (control group). Then, the ani mals were cooled and their livers were transplanted after 6 hr of cold isch emia. The animals were killed on the 5th day, liver damage was assessed on wedged liver biopsies by a semiquantitative analysis and by morphometric an alysis of the necrotic areas, and biliary tract damage by histological exam ination of the explanted liver. Results. Seventeen animals survived the study period. The histological para meters assessed (sinusoidal congestion and dilatation, sinusoidal infiltrat ion by polymorphonuclear cells and lymphocytes, endothelitis, dissociation of liver cell plates, and centrilobular necrosis) were significantly worse in the control group. The necrotic area affected 15.9+/-14.5% of the liver biopsies in the control group and 3.7+/-3.1% in the L-arginine group (P<0.0 5), Six of eight animal in the control group and only one of eight survivor s in the L-arginine group developed ischemic cholangitis (P<0.01), L-Argini ne administration was associated with higher portal blood flow (676.9+/-149 .46 vs. 475.2+/-205.6 ml.min.m(-2); P<0.05), higher hepatic hialuronic acid extraction at normothermic recirculation (38.8+/-53.7% vs. -4.2+/-18.2%; P <0.05) and after reperfusion (28.6+/-55.5% vs. -10.9+/-15.5%; P<0.05) and l ower levels of alpha-glutation-S-transferase at reperfusion (1325+/-1098% r espect to baseline vs, 6488+/-5612%; P<0.02). Conclusions. L-Arginine administration during liver procurement from non he art beating donors prevents liver and biliary tract damage.