Biological modulation of liver ischemia-reperfusion injury.
OBJECTIVE
This review gives a broad overview of the key factors of ischemic injury to the liver and presents the current modifications of preservation solutions and the few strategies of biological modulation in clinical use today.


RESULTS
Protective effects in human-liver transplantation were shown by methylprednisolone treatment in decreased donors, and by inhalation of a nontoxic dose of nitric oxide in recipients. In addition, recent results showed rescue of pig livers, donated after cardiac death by application of a cocktail of substances addressing several previously identified mechanisms of ischemia-reperfusion injury.


CONCLUSIONS
The future of a pharmacological approach attenuating or preventing ischemia-reperfusion injury lies in a combination of drugs acting simultaneously on several steps of the injury cascades. Applying these substances during flush, before, and during implantation appears as an attractive strategy to protect extended criteria liver grafts.
de Rougemont
Olivier
O
Department of Visceral and Transplantation Surgery, Swiss HPB and Transplant Center, University Hospital Zurich, Switzerland.
Dutkowski
Philipp
P
Clavien
Pierre-Alain
PA
D000818:Animals; D019610:Cytoprotection; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D009926:Organ Preservation / Q000009:adverse effects / Q000379:methods*; D019188:Organ Preservation Solutions / Q000627:therapeutic use*; D020011:Protective Agents / Q000627:therapeutic use*; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome
D019188:Organ Preservation Solutions; D020011:Protective Agents