Hepatic energy booster effect and lipo-modulatory effect on postreperfusional endotoxemia by intraoperative lipid infusion in porcine liver transplantation

We investigated whether intraoperative infusion of fat emulsion could suppress postoperative endotoxemia and improve energy status in the transplanted liver graft using a swine orthotopic liver transplantation (OLT) model. Intraoperative free fatty acid (FFA) concentration, hepatic FFA clearance, serum hyaluronic acid levels, ATP content and hepatic energy charge (HEC) in liver grafts, postreperfusional endotoxin levels and recipient outcome were compared between a fat emulsion-treated group (LCT- treated group, n = 6) and a saline infused-group (control group, n = 7). Independent of massive surgical stress and administration of heparin, FFA concentration was significantly elevated in the LCT-treated group (P = 0.003). Since FFA clearance, ATP contents and HEC were also increased in the LCT-treated group (P = 0.024, 0.006, 0.005, respectively), intraoperative LCT-treatment was shown to increase FFA concentration and improve energy status of liver grafts. Because there were no significant differences in postoperative hyaluronic acid levels, infused fat emulsion (0.1 g/kg per hour) prevented endothelial cell injury. Significant improvement of postoperative endotoxemia was obtained at 1 and 2 h after reperfusion (P = 0.01 and 0.003, respectively). Energy booster effect and antiseptic effect led to prolonged survival of recipients in the LCT-treated group (28.5 ± 13.3 days, P = 0.013 vs. control). We concluded that the hepatic energy booster effect and the lipo-modulatory effect on postreperfusional endotoxemia caused by intraoperative infusion of fat emulsion may be of great use in human liver transplantation. (C) 2000 Elsevier Science Ireland Ltd.