Major Hepatic Trauma: Warm Ischemic Tolerance of the Liver After Hemorrhagic Shock

• Published in: The Journal of surgical research Vol. 136; no. 1; pp. 70 - 77
• Main Authors: Perdrizet, George A., Giles, David L., Dring, Robert, Agarwal, Suresh K., Khwaja, Khalid, Gao, Yuan Z., Geary, Michael, Cowell, Vernon L., Berman, Martin, Brautigam, Robert
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2006; Elsevier
• Subjects: Acute Disease; Acute-Phase Reaction - physiopathology; Animals; Aspartate Aminotransferases - metabolism; Biological and medical sciences; Biopsy; Creatinine - blood; General aspects; hemorrhagic shock; Hot Temperature; Injuries of the abdomen. Foreign bodies of the digestive system; Ischemia - mortality; Ischemia - pathology; Ischemia - physiopathology; ischemia-reperfusion; Kidney - physiology; Lactic Acid - blood; Liver - pathology; Liver - physiopathology; Liver Circulation; liver injury; lung injury; Medical sciences; organ failure; Respiratory Mechanics; Resuscitation; second hit hypothesis; Shock, Hemorrhagic - mortality; Shock, Hemorrhagic - pathology; Shock, Hemorrhagic - physiopathology; Sus scrofa; Traumas. Diseases due to physical agents; venovenous bypass; Water-Electrolyte Balance; liver injury; lung injury; organ failure; hemorrhagic shock; venovenous bypass; ischemia-reperfusion; second hit hypothesis; Shock; Lung disease; Respiratory disease; Ischemia reperfusion; Tolerance; Hepatic disease; Hemorrhage; Hypothesis; Medicine; Treatment; Surgery; Liver trauma; Digestive diseases; Lesion; Failure; Venovenous bypass; Organ
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2006.06.032

The management of severe hepatic trauma frequently involves exposing the liver to varying periods of warm ischemia. The ischemic tolerance of the liver, in the setting of hemorrhagic shock (HS) and trauma, is presently unknown. We tested the hypothesis that warm ischemic tolerance of the porcine liver will be decreased following resuscitation from HS. Twenty-three Yorkshire pigs were divided into three groups: 1) hepatic ischemia alone (HI, n = 9); 2) hemorrhagic shock alone (HS, n = 3); and 3) hemorrhagic shock plus hepatic ischemia combined (HSHI, n = 11). Following reperfusion, a liver biopsy was obtained and serial blood chemistries were sampled. Post-operative day 7 mortality was increased in the HSHI group (7/11) compared to the HI (0/9) group, P = 0.038. Notably, deaths did not result from acute liver failure, but rather from intra-operative hemodynamic collapse shortly following hepatic reperfusion. In addition, the HSHI group experienced significantly elevated lactic acid, serum creatinine and liver enzyme levels. Analysis of the liver biopsy samples is consistent with a more severe liver injury in the HSHI group. The warm ischemic tolerance of the liver following resuscitation from HS is significantly decreased in this porcine model compared to HS or HI alone. Mortality was associated with acute intra-operative hemodynamic collapse occurring shortly after hepatic reperfusion.