Studies were made on the pathological lesions and biochemical indices of the livers of 22 patients in whom normal hemodynamics was maintained for 0-48 days after
brain death by administration of
vasopressin and
epinephrine. Thirty-one specimens of liver tissues were obtained by percutaneous biopsy or at autopsy. The degrees of central
venous congestion, central
fibrosis, focal
fibrosis, fatty metamorphosis, piecemeal
necrosis, periportal
fibrosis, and intrahepatic
cholangitis in livers on various days after
brain death were compared with those on the day of
brain death (day 0). Central
venous congestion was extensive on days 0-4, significantly less on days 5-14, and then again extensive on days 15-48. Central
fibrosis and focal
fibrosis showed no remarkable change during the 48-day period. Fatty metamorphosis, piecemeal
necrosis, and periportal
fibrosis showed no significant changes until day 16, but spread extensively on days 40-48. Intrahepatic
cholangitis was scarcely observed on day 0 but began to increase after day 3, and spread extensively after day 5. The level of serum
glutamic pyruvic transaminase did not increase in most patients until day 15. The mean value of
prothrombin activity also did not decrease until day 15. However, the mean value of serum
alkaline phosphatase increased gradually after day 3, and was correlated with
cholangitis. The present study showed that during prolonged hemodynamic maintenance of
brain-dead patients, pathological lesions did not spread or diminished and that biochemical indices did not become worse, or improved, in the first 2 weeks, except for increases in
cholangitis and the serum
alkaline phosphatase level.