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CARDIOVASCULAR ANESTHESIA

Ischemic Preconditioning Improves Energy State and Transplantation Survival in Obese Zucker Rat Livers

Claus U. Niemann, MD^*, Ryutaro Hirose, MD, Tao Liu, MD, Matthias Behrends, MD, Jaimi L. Brown, BS, Douglas F. Kominsky, PhD, John P. Roberts, MD, and Natalie Serkova, PhD

*Department of Anesthesia and Perioperative Care, Department of Surgery, Division of Transplantation, University of California, San Francisco, California; Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Essen, Germany; Department of Anesthesiology, Biomedical MRI/MRS, University of Colorado Health Sciences Center, Denver, Colorado

Address correspondence and reprint requests to Claus U. Niemann, MD, University of California at San Francisco, Department of Anesthesia and Perioperative Care, 521 Parnassus Avenue, C 450, San Francisco, CA 94143–0648. Address e-mail to niemannc{at}anesthesia.ucsf.edu.

Livers from obese donors often have fatty infiltrates and are more susceptible to ischemia-reperfusion injury and subsequent graft dysfunction. This often leads to the exclusion of organs from obese donors. We investigated whether ischemic preconditioning (IP, 10 min ischemia, 10 min reperfusion) preserves cellular metabolism in livers from obese Zucker rats during cold ischemia. Liver samples (–IP and +IP) were collected from obese and control lean rats at different time points of cold ischemia (CI) and analyzed by magnetic resonance spectroscopy (¹H- and ³¹P-MRS) to assess whether IP improves hepatic cellular metabolism. IP significantly improved high energy metabolism in IP livers from obese rats when compared with obese controls during the first hours of CI. At 4 h of cold storage, obese IP livers were not different from control lean non-IP livers. The beneficial metabolic effect of IP on livers form obese rats, however, was absent at 8 h of reperfusion. In contrast, in livers from lean rats, IP resulted in improved high-energy metabolism during the entire observation period of 8 h. In a later part of the study, IP of liver grafts from obese rats before 4 h of cold storage improved recipient survival after graft transplantation. IP of liver grafts from obese rats before 4 h of CI increases 24-h survival of recipient animals from 25% to 88%.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999