Development of a new method for hepatic rearterialization in rat orthotopic liver transplantation. Reduction of liver injury and improvement of surgical outcome by arterialization.

The purpose of this study was to develop a simple new method for rearterialization to compare rearterialized and nonarterialized models of liver transplantation in the rat in the same laboratory with the same surgeon. Hepatic rearterialization in the rat was completed by connecting the proper hepatic artery with a splint of polyethylene tubing (PE 10). With this technique, no extrahepatic arteries or modification of other organs was required. Further, the recipient's gastroduodenal artery remained intact to minimize bile duct hypoxia, and the anastomosis was completed rapidly (< 3 min). Postoperative arterial thrombosis and bile duct necrosis occurred with low frequencies with this model (< 15%). For comparison, the nonarterialized model of Kamada was used. With the nonarterialized method, survival of livers stored for 24 hr in cold University of Wisconsin solution was approximately 85% (6/7), whereas survival of livers stored for 48 hr was poor (< 10%; 1/16). Rearterialization improved survival following 48 hr of storage in UW solution from less than 10% to 50% (3/6), and reduced early enzyme release (AST) by about 50%. Rearterialization also reduced enzyme release following 24 hr of cold storage by about 50%. We conclude that this new technique is a simple and reliable method for hepatic artery reconstruction that may be particularly useful in studying the mechanism of primary graft non-function. These data are consistent with the hypothesis that hepatic rearterialization minimizes hypoxic injury to parenchymal cells postoperatively, most likely by increasing oxygen delivery.