Challenge of extending warm ischemic time in rat liver transplantation from cardiac death donors

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Liver transplant outcomes using grafts donated after cardiac death (DCD) remain poor. Our goal of this study was to extend the warm ischemic time in rat liver transplantation from DCD donors. For this purpose, it is important to control the ischemic/reperfusion (I/R) injury after transplantation. There are a couple of reports to prevent I/R injury, and we applied venous systemic oxygen persufflation (VSOP) and nitric oxide (NO) gas administration.Using rat liver transplantation models from 60 minutes DCD donors, VSOP-NO treatment could effectively decreasing the damage of I/R injury, leading to the better survival. However, we failed to extend the warm ischemic time by this methods. There may be a limitation in these graft reconditioning procedures, further investigation to understand this phenomena is required.