Background:

Preservation solutions such as University of Wisconsin solution and histidine-tryptophan-ketoglutarate solution have been cited as causes of hypotension and adverse donor reactions following reperfusion of donor livers. Flushing livers with crystalloid or colloid prior to transplantation has been proposed as a way to avoid the adverse effects of large volumes of preservation fluid entering the recipient system after reperfusion; however, choice of what solution, and what effect this might have on graft function, is unclear.

Method:

A retrospective review of all liver transplants preformed from 2012-2014 at OHSU was performed (n=70). Allografts were preserved with University of Wisconsin solution. Donor livers were flushed with either Hespan or Lactated Ringers (LR) during back table preparation. The effects of two flush solutions were compared. Outcomes included peak AST, ALT, change in bilirubin, change in Cr, and overall survival.

Results:

There was a statically significant difference in peak AST (p=0.04) and ALT (p=0.04), with the livers flushed with LR having higher peak AST (mean=1884 vs. 1183) and peak ALT (mean=1214 vs. 727) compared to livers flushed with Hespan. Recipient characteristics (age, preoperative MELD) as well as donor organ characteristics (donor age, warm ischemia time, total ischemia time) were not significantly different between the two groups. Postoperatively there was not a significant difference in peak creatinine, change in creatinine, post operative day 5 bilirubin or change in bilirubin. We found no significant difference between livers flushed with LR vs Hespan in terms of overall graft survival.

Conclusions:

Flush solution used in back table preparation of livers can have an impact on the physiology of the donor liver. Use of LR was associated with a statistically significant increase in peak AST and ALT when compared to Hespan. These increases could reflect hepatocyte damage which may be more physiologically significant in higher risk livers (long ischemia time, high risk donor, DCD donor etc). As we push for higher organ utilization it will be important to optimize all aspects of back table preparation including flush solution.

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