The influence of retrograde reperfusion on the ischaemia-/ reperfusion injury after liver transplantation in the rat

One of the most serious complications after liver transplantation (LTx) is the primary non-function (PNF). The frequency of the appearance of an organ failure is not exactly indicated in the literature (4.2–8.4%) (Ploeg et al. 1993; Porte et al. 1998; Moreno Sanz et al. 1999; Bennett-Guerrero et al. 2001). The influence of I/R-injury as a significant risk factor for PNF is widely unquestioned. The I/R-injury is responsible for approximately 10% of PNF after LTx (Fondevila et al. 2003). There is a high correlation between pre-existing damage of the liver and the I/R-injury (Briceno et al. 2002; Caraceni et al. 2005). Because of the increasing organ shortage, it is necessary to transplant every available organ and to develop new strategies to minimize the damage caused by conservation, ischaemia and reperfusion. Especially fatty livers are prone to this kind of damage and, accordingly, are more predisposed to PNF after LTx (Sun et al. 2001; Perez-Daga et al. 2006). The type of reperfusion during liver transplantation has an influence on I/R-injury (Brockmann et al. 2005; Polak & Porte 2006). In a number of studies which compare different kinds of antegrade reperfusion, no agreement could be reached concerning the question which type of reperfusion will lead to the lowest expression of I/R injury, though most studies have found the most positive effect in the simultaneous arterial and portal venous reperfusion (Massarollo et al. 1998; Brockmann et al. 2005). The primary retrograde reperfusion via the V. cava with the following reperfusion via the portal vein in the ‘Piggy Back technique’ is a new method in liver transplantation (Kneipeiss et al. 2003). So far, it has only been evaluated in two retrospective trials (Kniepeiss et al. 2003; Heidenhain et al. 2006). The aim of this trial was to compare the method of retrograde reperfusion with the common antegrade reperfusion methods in an animal model under standard conditions to evaluate if there is an advantage to this method.