Liver protection by hypothermic perfusion at different temperatures during total vascular exclusion

Introduction:Insitu hypothermic perfusion (HP) can be applied to attenuate ischemia and reperfusion (I/R) injury during liver resection under total vascular exclusion (TVE). This study examines the protective effect of cooling by HP at 20 and 28°C as compared with no HP during TVE in a porcine liver I/R model. Methods: Twenty‐one pigs underwent 60 min TVE of the liver followed by 24 h reperfusion. HP was performed via the portal vein using ringerlactate solution of 4°C. Pigs were assigned to three groups: TVE without HP (no‐HP, n =9), TVE with HP at 28°C (HP‐28, n =6) and TVE with HP at 20°C (HP‐20, n =6). Results: Perfusion volumes during TVE were 5.1±0.5 and 17.3±1.7 l in HP‐28 and HP‐20, respectively ( P <0.05). Aspartate aminotransferase (AST) after 24 h reperfusion was 1172±440 U/l in no‐HP as compared with 223±69 and 180±22 U/l in HP‐28 and HP‐20, respectively ( P <0.05). No differences in liver function or histopathology were found between the HP‐28 and HP‐20 groups. Conclusions: HP at 20°C is equally effective in preserving liver function and preventing hepatocellular injury under TVE as compared with HP at 28°C. HP at 28°C is advised, because of the lesser perfusion volume necessary for cooling of the liver.