Effects of 10 minutes of ischemic preconditioning of the cadaveric liver on the graft's preservation and function: the ying and the yang.
BACKGROUND
Although extensively studied in animal models, ischemic preconditioning has not yet been studied in clinical transplantation.


OBJECTIVE
To compare the results of cadaveric liver transplantation with and without ischemic liver preconditioning in the donor.


METHODS
Alternate patients were transplanted with liver grafts that had (n = 46, GroupPrecond) or had not (n = 45, GroupControl) been subjected to ischemic preconditioning. Liver ischemia-reperfusion injury, liver and kidney function, morbidity, and in-hospital mortality rates were compared in the 2 groups. Initial poor function was defined as a minimal prothrombin time within 10 days of transplantation <30% of normal and/or bilirubin >200 micromol/L.


RESULTS
The postoperative peaks of ASAT (IU/L) and ALAT (IU/L) were significantly lower in GroupPrecond (556 +/- 968 and 461+/-495, respectively) than in the GroupControl (1073 +/- 1112 and 997+/-1071, respectively). The rate of technical morbidity and the incidence of acute rejection were similar in both groups. Initial poor function was significantly more frequent in the GroupPrecond (10 of 46 cases) than in the GroupControl (3 of 45 cases). Hospital mortality rates were similar in the 2 groups. In multivariate analysis, body mass index of the donor, graft steatosis, and ischemic preconditioning were significantly predictive of the posttransplant peak of ASAT. In univariate analysis, only preconditioning was significantly associated with initial poor function.


CONCLUSIONS
Compared with standard orthotopic liver transplant, ischemic preconditioning of the liver graft in the donor is associated with better tolerance to ischemia. However, this is at the price of decreased early function. Until further studies are available, the clinical value of preconditioning liver grafts remains uncertain.
Centre Hépato-Biliaire, Département de Chirurgie Hépato-Biliaire, Hôpital Paul Brousse, Villejuif, France. daniel.azoulay@pbr.ap-hop-paris.fr
Daniel
D
Azoulay
Massimo
M
Del Gaudio
Paola
P
Andreani
Philippe
P
Ichai
Mylène
M
Sebag
René
R
Adam
Olivier
O
Scatton
Bao Yan
BY
Min
Valérie
V
Delvard
Antoinette
A
Lemoine
Henri
H
Bismuth
Denis
D
Castaing
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002102:Cadaver; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011336:Probability; D015427:Reperfusion Injury / Q000517:prevention & control; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome