LIVER PROTECTION DURING MAJOR LIVER RESECTION: THE EFFECT OF HYPOTHERMIA 120"C AND 28"Ci AND VASCULAR PERFUSION WITH TWO TYPES OF PRESERVATION SOLUTION IUW ANDHTKI

Abstract

The effects of liver 1/R injury are still a major concern during extensive liver resections in which clamping of the afferent vessels are necessary to minimize blood loss. Although extensive research has been conducted over the past decades to explore the mechanisms involved in 1/R injury, these complex mechanisms, involving several pathways, are not yet fully understood. Animal studies are still an important part of current research, especially when mechanistic issues are investigated.

The decrease in intra-operative and postoperative complications has improved the outcome of major liver surgery over the last decades. The reduction of intra-operative blood loss by clamping the afferent vessels to the liver, with or without clamping of the supra-hepatic and infra-hepatic caval vein, significantly contributed to this achievement. A further decrease in postoperative morbidity can be accomplished by reducing procedure related liver injury, such as 1/R injury. The objective of this study was to decrease liver 1/R injury by means of a decrease in core liver temperature of 1ooc or I8°C, achieved by in situ hypothermic perfusion of the liver during ischemia using three types of different perfusion solutions.

We stated in this study a pig model to be close to the human situation. This model has the disadvantage of poor porto­ systemic collaterals which necessitate intra-operative porto­ venous shunt. The hypotension resulting from caval clamping necessitate veno-venous bypass. To achieve these goals, a special prosthesis was designed.

To this end , liver ischemia was induced by total hepatic vascular exclusion without cold perfusion (control group) or with concomitant in situ perfusion by way of the hepatic artery, using hypothermic (4°C) Ringer-glucose, HTK or UW to reach a core liver temperature of either 28°C or 20°C (perfused groups