Fibrinolytic preflush upon liver retrieval, from non-heart beating donors to enhance postpreservation viability and energetic recovery upon reperfusion

Background. Our objective was to evaluate graft equilibration with high vis cosity (University of Wisconsin solution [UW]) or low viscosity (Bretschnei der's histidine-tryptophan-ketoglutarate [HTK]) during liver procurement fr om non-heart beating donors (NHBD) and the potential impact of a preceding fibrinolysis with streptokinase on postpreservation viability. Methods. After 60 min of cardiac arrest, rat livers were perfused by gravit y (60 cm H2O) via the portal vein with either 60 mi of HTK, 20 ml of UW, or 20 mi of Ringer's solution (22 degreesC including 7500U of streptokinase) and, subsequently, 20 mi of UW, After 24 h of storage at 4 degreesC, viabil ity of the livers was assessed upon isolated reperfusion in vitro. Results. Magnetic resonance imaging revealed severe perfusion deficits, whi ch were mildly attenuated with HTK, upon flush-out with UW. After preflush with streptokinase, a mostly homogenous distribution of the preservation so lution was observed throughout the liver tissue. The choice of the flush-ou t solution (UW or HTK) had no influence on parenchymal enzyme leakage, hepa tic bile production, or tissue levels of ATP after reperfusion of the liver s. Fibrinolytic preflush, however, resulted in a relevant and significant i mprovement of structural integrity as well as functional and metabolic reco very. Conclusions. Compromised vascular tissue perfusion upon organ harvest in NH BD triggers graft dysfunction after cold storage and can easily be circumve nted by temporary fibrinolysis before graft retrieval.