Influence of donor cardiopulmonary arrest in human liver transplantation: possible role of ischemic preconditioning.
Hepatic allografts from donors who have suffered a brief cardiopulmonary arrest may sustain ischemic damage before organ procurement. However, there is no reported correlation between donor cardiopulmonary arrest and hepatic allograft dysfunction. On the other hand, brief ischemia-reperfusion injury has been shown experimentally to result in protection in several organ models. Induction of ischemic tolerance has been called ischemic preconditioning. Our objective was to study the influence of brief donor cardiopulmonary arrest on hepatic allograft outcome in human liver transplantation. Between May 1997 and July 1998, 181 consecutive orthotopic liver transplant (OLT) cases were divided into 2 groups based on the occurrence of donor cardiopulmonary arrest. Group A consisted of 37 donors who suffered a cardiopulmonary arrest. Group B consisted of the remaining 144 patients. Liver graft survival within 90 days of OLT and early postoperative graft function were analyzed. Although there was significant liver damage resulting from circulatory failure during cardiopulmonary arrest before organ procurement in group A, graft survival was not affected. After OLT, the mean peak aspartate transaminase and alanine transaminase concentrations in group A (1, 444.1 and 718.2 U/L) were significantly lower than those in group B (2,382.8 and 1,507.3 U/L) (P <.05). Experiences of brief cardiopulmonary arrest in organ donors did not affect post-OLT hepatic allograft survival and function. Although the liver function tests are elevated in an organ donor, the hepatic allograft is suitable for OLT if the liver damage is induced by brief donor cardiopulmonary arrest.
Totsuka
E
E
Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA. etotsuka@cc.hirosaki-u.ac.jp
Fung
J J
JJ
Urakami
A
A
Moras
N
N
Ishii
T
T
Takahashi
K
K
Narumi
S
S
Hakamada
K
K
Sasaki
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology*; D006801:Humans; D019194:Ischemic Preconditioning; D008099:Liver / Q000503:physiopathology; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome