Background: The continuous success of orthotopic liver transplantation (OLT) is accompanied by an increased need for available organs. The consequential wider use of marginal organs in recent years have lead to a resurgence of interest in strategies to optimize the condition of available organs. In this constellation the need for Minimization Ischemia/reperfusion (IR) injury during the preservation period is very important. The tolerance of the liver against warm ischemia is well known from liver resection techniques. The aim of this study was to analyze the feasibility of warm-ischemia (WI-group) procurement and immediate liver transplantation.

Methods: During January 1st 2006 and January 1st 2012 6 patients underwent warm ischemia OLT at our institution with in-house organ retrieval and immediate liver transplantation under warm ischemic conditions. Comparison was made to a matched pair group of patients with standard cold preservation.

Results: Livers were transplanted with initial portalvenous reperfusion and a warm ischemia time varying from of 29-43 minutes. Postoperative alanine aminotransferase (ALT) and aspartate aminotransferase (AST) values were significantly decreased in the WI-group, when compared with the matched-pair controls. Also postoperative TPZ-values were significantly increased in the WI-group. There were no differences observed in the long-term follow-up.

Conclusion: The results of our study demonstrate that liver transplantation with a controlled warm ischemia is a safe and technically feasible approach with potentially reduced IR. This might be relevant in conditions assumed for a high susceptibility to cold ischemia, e.g. extended criteria grafts. This logistically challenging approach may therefore be considered in individual patients to eventually improve postoperative organ quality and clinical outcome.

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