Liver Preservation

Liver function and success after transplantation is dependent not only on donor and recipient factors, but also on good preservation. Preservation of the liver not only involves preservation of the parenchyma, but also preservation of the biliary epithelium, as well as the vascular endothelium, particularly the endothelium of the hepatic artery. Prior to the development of UW solution,

Table 5.5. Components of the University of Wisconsin (UW) Solution

Lactobionate (K) 100 mmol/L

KH2PO4 25 mmol/L

Glutathione 3 mmol/L

Adenosine 5 mmol/L

MgSO4 5 mmol/L

Allopurinol 1 mmol/L

Raffinose 30 mmol/L

HES 5 g/dL

liver preservation was limited to approximately 6 hours. After the clinical introduction of UW solution, it was believed that extended preservation beyond 12 hours was safe. However, it became apparent that rates of primary nonfunction, biliary complications, and hepatic artery thrombosis increased as preservation time increased. Also, preservation injury may lead to increased rates of rejection via upregulation of MHC class I and II antigens, which in turn may lead to graft loss. Although preservation beyond 12 hours can be achieved, rates of primary nonfunction and initial poor function are increased. For this reason, most transplant centers attempt to limit preservation of the liver to 12 hours or less. In an era of donor shortages, every effort should be made to minimize retransplant rates and this can be achieved by minimizing cold ischemia times. Longer term preservation may only be achieved by machine perfusion which has been shown experimentally to be more successful than cold storage.

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