Effect of ischemic preconditioning in whole liver transplantation from deceased donors. A pilot study.
The effect of ischemic preconditioning (IPC) in orthotopic liver transplantation (OLT) has not yet been clarified. We performed a pilot study to evaluate the effects of IPC in OLT by comparing the outcomes of recipients of grafts from deceased donors randomly assigned to receive (IPC+ group, n = 23) or not (IPC- group, n = 24) IPC (10-min ischemia + 15-min reperfusion). In 10 cases in the IPC+ group and in 12 in the IPC- group, the expression of inducible nitric oxide synthase (iNOS), neutrophil infiltration, and hepatocellular apoptosis were tested by immunohistochemistry in prereperfusion and postreperfusion biopsies. Median aspartate aminotransferase (AST) levels were lower in the IPC+ group vs. the IPC- group on postoperative days 1 and 2 (398 vs. 1,234 U/L, P = 0.002; and 283 vs. 685 U/L, P = 0.009). Alanine aminotransferases were lower in the IPC+ vs. the IPC- group on postoperative days 1, 2, and 3 (333 vs. 934 U/L, P = 0.016; 492 vs. 1,040 U/L, P = 0.008; and 386 vs. 735 U/L, P = 0.022). Bilirubin levels and prothrombin activity throughout the first 3 postoperative weeks, incidence of graft nonfunction and graft and patient survival rates were similar between groups. Prereperfusion and postreperfusion immunohistochemical parameters did not differ between groups. iNOS was higher postreperfusion vs. prereperfusion in the IPC- group (P = 0.008). Neutrophil infiltration was higher postreperfusion vs. prereperfusion in both groups (IPC+, P = 0.007; IPC-, P = 0.003). Prereperfusion and postreperfusion apoptosis was minimal in both groups. In conclusion, IPC reduced ischemia/reperfusion injury through a decrease of hepatocellular necrosis, but it showed no clinical benefits.
Liver and Multiorgan Transplant Unit, Department of Surgery and Transplantation, University of Bologna, Bologna, Italy.
Matteo
M
Cescon
Gian Luca
GL
Grazi
Alberto
A
Grassi
Matteo
M
Ravaioli
Gaetano
G
Vetrone
Giorgio
G
Ercolani
Giovanni
G
Varotti
Antonietta
A
D'Errico
Giorgio
G
Ballardini
Antonio Daniele
AD
Pinna
D000328:Adult; D000368:Aged; D017209:Apoptosis; D001706:Biopsy; D002102:Cadaver; D005260:Female; D006801:Humans; D019194:Ischemic Preconditioning; D016031:Liver Transplantation / Q000401:mortality / Q000473:pathology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome