Rapid donor liver nutritional enhancement in a large animal model

Organ donors are typically subject to acute hyponutrition that might affect postpreservation liver function. Livers from nutritionally supplemented rats function better after preservation than livers from fasted rats. We have developed a method to glycogenate the liver of large animals in the temporal context of a human donor liver operation and have studied the fate of glycogen stores during preservation. Starved anesthetized pigs were infused with a hexose solution (glucose, fructose or galactose) by way of the superior mesenteric vein for 3 hr. Regular porcine insulin was infused to maintain a hyperglycemic hyperinsulinemic arterial glucose clamp at 12 to 16 mmol/L. Liver biopsy specimens and blood samples were taken before infusion and hourly. At 3 hr the liver was excised, stored for 24 hr at 1°C in University of Wisconsin solution and biopsied. It was then placed at 20° C for 1 hr to simulate the reimplantation stage of transplantation. Glycogen and nucleotide levels were measured, and results were corrected for starch in the University of Wisconsin solution. A 20% glucose infusion produced rapid hepatic glycogenation without side effects. Greater glycogenation was obtained with 20% fructose but at the cost of lactic acidosis and a fall in pH. A combination of 15% glucose and 5% fructose produced intermediary glycogenation without significant side effects. Galactose (20%) was less efficient than glucose alone. The addition of alanine and glutamine (20 mmol/L) did not significantly improve glycogenation. Metabolism of glycogen at 1° C did occur. Glycogen content fell 0.15% ± 0.05% dry weight liver per hour during cold preservation and 5.49% ± 2.15% per hour during ischemic rewarming. The rate of glycogen depletion during rewarming was dependent on the amount of glycogen available at the start of the period. Phosphorylated nucleotide levels were maintained at significantly higher levels in glycogenated livers. Periodic acid–Schiff staining showed a clear gradient of glycogenation maximal in zone 1 and minimal in zone 3. Rapid hepatic glycogenation is possible and beneficial in terms of maintaining adenine nucleotide levels in a large animal model. (HEPATOLOGY 1992;16:1271–1279.)