Comparison of combined portal-arterial versus portal perfusion during liver procurement

PAP of harvested livers is routinely used to minimize parenchymal anoxia during storage. PP is compared with PAP to evaluate the relative reliability of PAP. Sixty female Landrace pigs were used for 30 OLTs. Group 1 livers underwent PP, whereas group 2 livers were treated with PAP. The cold ischemic item was less than 120 minutes for both groups, with no warm ischemia. Intraoperative and 24-hour postoperative biochemical, coagulation, and histocytological data were analyzed. Morphological studies of cellular damage were based on the percentage of CVD and KP and classified as light, moderate, and severe damage. Data, at closing, were compared by using Fisher's test (group 1 v group 2, P = 0.003 for light damage and P = .04 for severe damage; first postoperative day for group 1 v group 2, P = .133 for light damage and P = .25 for severe damage. Blood samples at closing and 24 hours postoperatively showed significant differences between groups 1 and 2: At closing for groups 1 and 2, respectively: AST, 968.9 ± 742.7 and 327.4 ± 174.7 IU/L (P < .001); ALT, 63.1 ± 40.3 and 20.3 ± 5.3 IU/L (P < .001); AP, 292.2 ± 107.1 and 139.5 ± 45.3 IU/L (P < .001); and 24 hours postoperatively for groups 1 and 2, respectively: AST, 1,664.9 ± 917.8 and 419.3 ± 230.9 IU/L (P < .001); ALT, 180.4 ± 28.9 and 66.4 ± 17.5 IU/L (P < .001); AP, 602.1 ± 153.3 and 255.7 ± 116.3 IU/L (P < .01). Comprehensively, the results reflect a better perfusate distribution of the PAP livers compared with PP ones: uniform organ preservation, faster metabolic recovery, and reduced postoperative mortality.