Hepatic cell membrane damage during cold preservation sensitizes liver grafts to rewarming injury

Background/Purpose . Increasing levels of glycerol in extracellular fluid indicate cell membrane disintegration, and can be continuously monitored with microdialysis. The aim of this study was to monitor liver cell membrane damage during liver transplantation in a pig model. Methods. Thirteen donor and recipient pairs were divided into two groups; group I, with a liver ischemia time of 5 h ( n = 6), and group II, with 15 h of ischemia ( n = 7). Microdialysis samples from the liver graft were collected at 20-min intervals during donor operation, cold preservation, implantation, and reperfusion in the recipient. Glycerol concentrations were analyzed. Results. During cold preservation, a continuous increase in glycerol levels was observed. This increase correlated with the time of cold ischemia ( r 2 = 0.88). During implantation, an accelerated increase of glycerol was observed, with a higher acceleration in group II ( P ≪ 0.005). During the first hour after reperfusion, a higher release of glycerol was observed in group II ( P = 0.0005). Conclusions. Our data show a constant glycerol release during cold storage, indicating a continuous injury to the cell membranes over time. Improvement in cell membrane protection during cold preservation could lead to improvement in liver transplantation outcome and acceptance of an extended period of cold ischemia.