Intramucosal pH and Serum Endotoxin Concentrations- Early Predictive Parameters for a Negative Outcome after Experimental Liver Transplantation in Pigs*

Octavian Bud1, Markus Golling1, Moritz von Frankenberg1, Arianeb Mehrabi1,
Thomas Kraus1, Maria Martha Gebhard2, Renate Urbaschek3, Christian Herfarth1, Ernst Klar1
1) Department of General Surgery, University of Heidelberg. 2) Department of Experimental Surgery, University of Heidelberg. 3) Institute for Microbiology, Mannheim Community Hospital, University of Heidelberg, Germany


Introduction. An early detection of graft primary non-function would bring significant advantages especially concerning the evaluation of a possible retransplantation. The aim of the study was to evaluate the predictive value for the negative outcome after orthotopic liver transplantation (OLT) of gastric/sigmoid intramucosal pH (pHi) and serum endotoxin (LPS) concentrations during experimental OLT in pigs.

Material and methods
. In 16 pairs of German landrace pigs OLT was performed using University of Wisconsin (UW) solution as the conservation agent (cold ischaemia time: 242±53 min). Gastric and sigmoid pHi as well as portal and systemic LPS were measured in recipient after laparatomy (Phase A), at the end of the anhepatic phase (Phase B) and one hour after reperfusion (Phase C). The animals were stratified in 2 groups: survivors (n=11) and non-survivors (n=5). The differences between groups were assessed using the Mann-Whitney U-test.

Results. One hour after reperfusion the gastric (7.30±0.04) and sigmoid (7.31±0.03) pHi levels in the survivors group recovered to levels comparable to the initial values, while in the non-survivors group they remained at substantial lower values (gastric: 7.27±0.02; sigmoid: 7.26±0.02)(p<0.01). One hour after reperfusion the portal (69±23 pg/mL) and systemic (24±13 pg/mL) LPS concentrations in the survivors group were significantly lower than those in the non-survivors group (portal: 113±31 pg/mL; systemic 61±7 pg/mL)(p<0.01). Sigmoid pHi and systemic LPS concentrations had the highest sensitivity, specificity and positive predictive value for nonsurvival after OLT.

Key words

Intramucosal pH (pHi) _ endotoxin _ primary non function _ liver transplantation