Liver Preservation : The Past and the Future JAN

The ultimate objective of organ preservation is unrestricted and immediate graft function after a transplant under optimal conditions in the most suitable recipient. This means that time and efficacy are the basic features of the search for the ideal preservation method. Theoretically, freezing and continuous aerobic perfusion are the only means of obtaining truly long-term preservation (from a month to years). From a clinical point of view, however, the preferred method of preserving livers for brief periods before transplantation is simple cold storage (1). Until recently, cold storage of the graft in Collins’ solution provided acceptable graft function when preservation time was 8 hr or less (2). Still, in the first report of the European Liver Transplant Registry (31, reviewing 1,315 liver transplantations performed at 32 different centers from 1968 to 1987, one of the principal causes of loss of the graft (and occasionally of death of the patient) appeared to be the so-called “primary nonfunction” of the liver. In most cases this was thought to be through an injury caused by inadequate preservation. To keep the period of cold storage to a minimum, close coordination of two full surgical teams -one for the donor and one for the recipient was necessary, and the recipient operation had to be performed as an emergency procedure, often at night. Furthermore, only a very narrow margin of safety existed in the storage time, in case of unforeseen delays or unanticipated, timeconsuming difficulty in the recipient operation. To evaluate the possibility of liver transplantation on a (semi-) elective basis, Belzer (4) looked at the clinical needs for preservation times and concluded that 12 to 18 hr was necessary for liver transplantation to be performed electively. Similar to kidney transplantation, (semi-) elective liver transplantation will yield substantial benefits: because simultaneous donor and recipient operations are not required, an unnecessary recipient laparotomy may be prevented if the donor organ appears unsuitable for transplantation. Furthermore, if laparotomy findings indicate that the recipient is unsuitable for