Reliable indices for the determination of viability of grafted liver immediately after orthotopic transplantation. Bile flow rate and cellular adenosine triphosphate level

One of the major problems accompanying liver transplantation is how to evaluate the viability of the grafted tissue at an early stage. The ability to assess immediate graft function would provide results useful in the determination of prognosis. The present study was undertaken to determine whether bile flow rates after liver transplantation were correlated with adenosine triphosphate levels and the survival of rats given transplants. In fresh-liver-transplanted rats, the one-week survival rate was 87%. The cellular ATP levels in the grafts decreased sharply prior to portal-venous declamping, but returned to nearly 80% of the normal level 4 hr after grafting, as did the total adenine nucleotide level and energy charge. When the grafts were subjected to warm ischemia for 15-min or 30-min periods prior to harvesting of the donor liver, the one-week survival rates decreased to 50% and 0%, respectively. In these cases, the levels of cellular ATP and bile secretion remained low and were proportional to the survival of the transplanted animals even 4 hr after transplantation. The relationship between the bile flow rates and the cellular ATP levels under various conditions revealed a good correlation, showing a saturation curve. The bile flow rates as well as the cellular ATP levels were therefore related to the survival rates of the transplanted animals. Thus it was shown in this experimental transplantation model that the monitoring of bile production after liver grafting is a useful indicator for assessing the extent of ischemic damage to the liver and for prognosis of the animal.