Introduction: The most vulnerable part in liver transplantation remains the biliary system. There is evidence, that insufficient perfusion during multi-organ procurement plays a major role in the pathogenesis of post-transplant ischemic damages leading to morbidity and mortality as well as graft loss. Due to frequent haemodynamic instability of the donor, there is a necessity for catecholamine application in a high percentage of procurement operations. Evidentially the flow rate inside the hepatic artery is decreased in the presence of catecholamines.

Material and methods: Fifteen German landrace pigs underwent multiorgan procurement receiving in situ and ex situ perfusion consecutively while external pressure was applied to the perfusion solution and increased stepwise. Arterial flow rates and pressure in the hepatic and renal artery were measured before and during perfusion. Five animals received catecholamines over a period of 30min prior to in situ perfusion. In order to visualise the perfusion success on the microcirculation, coloured MP were administered after perfusion and detected by microscopy.

Results: Ex situ perfusion was able to generate significantly higher values of pressure and flow at all measuring positions compared to in situ perfusion. When comparing the catecholamine group to the non-treatment group, in situ perfusion deteriorated under catecholamine treatment while ex situ perfusion achieved higher values of flow and pressure. MP count revealed the same pattern underlining these observations.

Conclusion: Our results point out the crucial importance of arterial ex situ pressure perfusion, especially in case of previous catecholamine exposure.

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