Immunological reactions in liver graft perireperfusion in living donor liver transplantation--change of expression of adhesion molecules, deposition of immunoglobulins and cytokine level.
OBJECTIVE
In liver transplantation from living donors, injury of graft by operative procedure might be a potential risk for the deterioration of the liver graft. To clarify influences of the surgical procedures on the graft we investigated indices of immunological reactions in the graft and change of blood cytokine levels in the early period after transplantation.


METHODS
Subjects were ten patients who received living donor liver transplantation. Two cases with ABO incompatibility and one case with positive crossmatch were included. Liver biopsy was taken at laparotomy, graftectomy, 6 hours after reperfusion. Liver function parameters, blood cytokines (IL-6, IL-8, and TNF alpha), expression of adhesion molecules (ICAM-1, ELAM-1, LFA-1 and SleX), and immunoglobulins deposition in the graft were examined to evaluate the degree of immunological reaction.


RESULTS
Slight elevation of the total bilirubin and ALT was recognized after reperfusion. Elevation of blood cytokine levels was observed six hours after reperfusion and these values normalized within two days. Expressions of adhesion molecules in vessels were not enhanced except ELAM-1 of the hepatic vein. Infiltration of LFA-1 or SleX-positive cells was observed at graftectomy and reperfusion. No increment of IgG deposition was recognized in vessels even in anti-donor antibody positive cases but deposition of IgA and IgM increased only in the sinusoids.


CONCLUSIONS
These results suggested that immunological reactions were generated by the operative procedure in the liver graft to some extent but the graft viability was not severely affected and that antibodies did not play important roles in liver injury in the early period after transplantation, even in anti-donor antibody positive cases.
Ohkohchi
Nobuhiro
N
Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, Tennoudai 1-1-1, Tsukuba, Japan. nokochi3@md.tsukuba.ac.jp
Hirano
Takuji
T
Satake
Masahiro
M
Satomi
Susumu
S
D000293:Adolescent; D015815:Cell Adhesion Molecules / Q000097:blood; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood*; D019040:E-Selectin / Q000097:blood; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008099:Liver / Q000098:blood supply / Q000276:immunology*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000276:immunology / Q000502:physiology*; D019520:Living Donors; D008297:Male; D011184:Postoperative Period
D015815:Cell Adhesion Molecules; D016207:Cytokines; D019040:E-Selectin; D018799:Intercellular Adhesion Molecule-1