Introduction Liver transplantation (OLT) currently represents the best therapy for end stage liver disease. The improvement in OLT results in the last two decades was mainly due to the improvement in seve- ral fields of OLT patho-physiological knowledge su- ch as immunosuppression, graft preservation, anae- sthesiology and intensive care support, new surgical and anaesthesiological technologies. Among the wide spectrum of patho-physiological aspects involved du- ring OLT, thermal homeostasis gains a crucial role since it influences critically both the liver recipient organism during OLT and the liver graft preserva- tion. Thermal homeostasis and liver recipient organism OLT candidate has generally hemodynamic and haemostatic problems due to the hepatic disease whi- ch may be exponentially increased by a very difficult surgical procedure such as OLT. The main patho-physiological risks during OLT are in fact intraoperative bleeding favoured by haemo- static disorders, hemodynamic instability and postre- perfusion syndrome. Severe hypothermia may potentially have a criti- cal role in determining all these events: 1. Hypothermia contributes to the hemorrhagic diathesis during OLT: the series of enzymatic reactions of the coagulation cascade are in fact Thermal homeostasis and liver transplantation Dav ide Francesco D’Amico, Alessandro Vitale, Umberto Cillo, Patriz ia Boccagni, Alberto Brolese, Giacomo Z anus, M arco Bassanello, Umberto M ontin, Enrico Gringeri, Francesco D’Amico, Francesco Ciarleglio, Gianluca Cappuz z o, Amedeo Carraro Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy Abstract. Thermal homeostasis represents the major issue during liver transplantation (OLT) since severe hypothermia may have a deleterious effect on both liver recipient organism and postoperative graft functio- ning. Because of the known negative influence of hypothermia on intraoperative cardiovascular activity and coagulation system, numerous methods have been suggested to reduce intraoperative heat loss and promote active warming (continuous temperature monitoring, external heat sources, improvement in surgical techni- que and technologies). A good intraoperative OLT course has an obvious influence on post OLT graft func- tion recovery, but thermal homeostasis has also an essential direct effect on the graft as a constitutive com- ponent of conventional cold preservation methods. H ypothermia, however, contributes directly to the graft ischemia-reperfusion injury particularly in marginal and partial organs by several angiogenic mechanisms. For these reasons, on the light of the development of new strategies to increase the donor pool, clinical re- search is focusing on new preservation methods such as extracorporeal circuits with normothermic oxygena- ted perfusion. Key words: H ypothermia, liver transplantation, graft C O N F E R E N C E R E P O R T ACTA BIO MEDICA 2003; 74; Suppl. 2: 30-33 © ATTIOLI 885