High concentrations of adenosine are needed in Carolina rinse to prevent activation of Kupffer cells.

Adenosine is a key component of Carolina rinse solution, which was developed to prevent an O2-dependent reperfusion injury following liver transplantation. Kupffer cells are activated following liver transplantation, an effect minimized by adenosine. In this study, the concentration of adenosine was varied in Carolina rinse, Ringer's, and Ringer's containing hydroxyethyl starch. Following 24 h of cold storage in University of Wisconsin cold storage solution, colloidal carbon uptake was measured to assess phagocytosis by Kupffer cells. Carbon uptake was elevated significantly in this model from values of 136 +/- 15 in unstored control livers to 187 +/- 25 mg/g per hour following a rinse with 10 ml of Ringer's solution. Phagocytosis was reduced about 50% when 0.1 mM adenosine was added to the Ringer's solution; however, addition of up to 1 mM adenosine in Carolina Rinse did not prevent elevated phagocytosis. In contrast, values were reduced significantly by addition of 5-10 mM adenosine to Carolina Rinse or Ringer's containing hydroxyethyl starch. Thus, the higher concentrations of adenosine needed to reduce Kupffer cell activation can best be explained by binding of adenosine to hydroxyethyl starch.