Ischemic pre-conditioning in deceased donor liver transplantation: a prospective randomized clinical trial.
To assess the immediate and long-term effects of ischemic preconditioning (IPC) in deceased donor. liver transplantation (LT), we designed a prospective, randomized controlled trial involving 60 donors: control group (CTL, n = 30) or study group (IPC, n = 30). IPC was induced by 10-min hiliar clamping immediately before recovery of organs. Clinical data and blood and liver samples were obtained in the donor and in the recipient for measurements. IPC significantly improved biochemical markers of liver cell function such as uric acid, hyaluronic acid and Hypoxia-Induced Factor-1 alpha (HIF-1 alpha) levels. Moreover, the degree of apoptosis was significantly lower in the IPC group. On clinical basis, IPC significantly improved the serum aspartate aminotransferase (AST) levels and reduced the need for reoperation in the postoperative period. Moreover, the incidence of primary nonfunction (PNF) was lower in the IPC group, but did not achieve statistical significance. We conclude that 10-min IPC protects against I/R injury in deceased donor LT.
Amador
A
A
Hospital de Sabadell, Consorci Sanitari Parc Taulí, Hepato-Biliary-Pancreatic Surgery Unit, Catalonia, Barcelona, Spain. 32504aam@comb.es
Grande
L
L
Martí
J
J
Deulofeu
R
R
Miquel
R
R
Solá
A
A
Rodriguez-Laiz
G
G
Ferrer
J
J
Fondevila
C
C
Charco
R
R
Fuster
J
J
Hotter
G
G
García-Valdecasas
J C
JC
D017209:Apoptosis; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000378:metabolism; D015153:Blotting, Western; D053148:Caspase 3 / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000378:metabolism; D051795:Hypoxia-Inducible Factor 1, alpha Subunit / Q000378:metabolism; D020287:In Situ Nick-End Labeling; D019194:Ischemic Preconditioning / Q000379:methods*; D008099:Liver / Q000378:metabolism / Q000473:pathology; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000378:metabolism / Q000473:pathology / Q000517:prevention & control; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D014527:Uric Acid / Q000378:metabolism
D015415:Biomarkers; C497442:HIF1A protein, human; D051795:Hypoxia-Inducible Factor 1, alpha Subunit; D014527:Uric Acid; D006820:Hyaluronic Acid; D001219:Aspartate Aminotransferases; D053148:Caspase 3