and Serum Endotoxin Concentrations- Early Predictive Parameters
for a Negative Outcome after Experimental Liver Transplantation
Octavian Bud1, Markus Golling1, Moritz von Frankenberg1, Arianeb
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.
Intramucosal pH (pHi) _ endotoxin _ primary non function _ liver