title: Ischaemic preconditioning of the graft in adult living related right lobe liver transplantation: impact on ischaemia-reperfusion injury and clinical relevance.
abstract: BACKGROUND
  Ischaemic preconditioning (IPC) of the right liver graft in the donor has not been studied in adult-to-adult living related liver transplantation (LRLT).
  
  
  OBJECTIVE
  To assess the IPC effect of the graft on ischaemia reperfusion injury in the recipient and compare recipient and donor outcomes with and without preconditioned grafts.
  
  
  METHODS
  Alternate patients were transplanted with right lobe grafts that were (n = 22; Group (Precond)) or were not (n = 22; Group (Control)) subjected to IPC in the living donor. Liver ischaemia-reperfusion injury, liver/kidney function, morbidity/mortality rates and outcomes were compared. Univariate and multivariate analyses were performed to identify factors predictive of the aspartate aminotransferase (AST) peak and minimum prothrombin time.
  
  
  RESULTS
  Both groups had similar length of hospital stay, morbidity/mortality, primary non-function and acute rejection rates. Post-operative AST (P = 0.8) and alanine aminotransferase (ALT) peaks (P = 0.6) were similar in both groups (307 +/- 189 and 437 +/- 302 vs. 290 +/- 146 and 496 +/- 343, respectively). In univariate analysis, only pre-operative AST and warm ischemia time (WIT) were significantly associated with post-operative AST peak (in recipients). In multivariate analysis, the graft/recipient weight ratio (P = 0.003) and pre-operative bilirubin concentration (P = 0.004) were significantly predictive of minimum prothrombin time post-transplantation.
  
  
  CONCLUSIONS
  Graft IPC in the living related donor is not associated with any benefit for the recipient or the donor and its clinical value remains uncertain.
authors.affiliation: Département de Chirurgie Hépato-Biliaire, Centre Hépato-Biliaire, IFR 89.9, France.
authors.forename: Paola
authors.initials: P
authors.lastname: Andreani
authors.forename: Emir
authors.initials: E
authors.lastname: Hoti
authors.forename: Sofia
authors.initials: S
authors.lastname: de la Serna
authors.forename: Davide
authors.initials: D
authors.lastname: degli Esposti
authors.forename: Mylène
authors.initials: M
authors.lastname: Sebagh
authors.forename: Antoinette
authors.initials: A
authors.lastname: Lemoine
authors.forename: Philippe
authors.initials: P
authors.lastname: Ichai
authors.forename: Fauzi
authors.initials: F
authors.lastname: Saliba
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D001777:Blood Coagulation; D005260:Female; D005602:France; D006801:Humans; D019194:Ischemic Preconditioning / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011517:Prothrombin Time; D015427:Reperfusion Injury / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000009:adverse effects
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases
references.citation: Radiology. 1981 Nov;141(2):525-7
references.pmid: 6974875
references.citation: Hepatology. 2000 Mar;31(3):577-80
references.pmid: 10706545
references.citation: Transplantation. 2001 Mar 27;71(6):812-4
references.pmid: 11330547
references.citation: BJU Int. 2000 Jun;85(9):1007-13
references.pmid: 10848685
references.citation: J Lab Clin Med. 1996 Sep;128(3):251-8
references.pmid: 8783632
references.citation: Clin Transplant. 2010 May-Jun;24(3):334-40
references.pmid: 19712082
references.citation: Surg Gynecol Obstet. 1992 Sep;175(3):270-2
references.pmid: 1514163
references.citation: Hepatology. 1997 Mar;25(3):658-63
references.pmid: 9049215
references.citation: Transplantation. 2001 Sep 15;72(5):861-8
references.pmid: 11571451
references.citation: Transplantation. 1997 Nov 15;64(9):1300-6
references.pmid: 9371672
references.citation: Ann Intern Med. 1979 Feb;90(2):185-7
references.pmid: 443650
references.citation: Ann Surg. 2003 Feb;237(2):180-5
references.pmid: 12560775
references.citation: Liver Transpl. 2001 Apr;7(4):292-9
references.pmid: 11303287
references.citation: Surg Today. 2002;32(1):1-12
references.pmid: 11871810
references.citation: J Cereb Blood Flow Metab. 2002 Nov;22(11):1283-96
references.pmid: 12439285
references.citation: Ann Surg. 2003 Dec;238(6):843-50; discussion 851-2
references.pmid: 14631221
references.citation: Liver Transpl. 2004 Feb;10(2):264-72
references.pmid: 14762865
references.citation: Liver Transpl. 2000 Nov;6(6 Suppl 2):S66-72
references.pmid: 11084089
references.citation: Surgery. 2004 Feb;135(2):203-14
references.pmid: 14739856
references.citation: Circulation. 1986 Nov;74(5):1124-36
references.pmid: 3769170
references.citation: Transplantation. 1994 Apr 15;57(7):1127-30
references.pmid: 8165712
references.citation: FASEB J. 2005 Oct;19(12):1617-26
references.pmid: 16195370
references.citation: Ren Fail. 1997 Jan;19(1):47-60
references.pmid: 9044451
references.citation: Ren Fail. 1999 Mar;21(2):135-45
references.pmid: 10088174
references.citation: Arch Surg. 2001 Nov;136(11):1263-6
references.pmid: 11695970
references.citation: Transplant Proc. 1993 Dec;25(6):3303-4
references.pmid: 8266552
references.citation: Am J Physiol Gastrointest Liver Physiol. 2003 Jan;284(1):G15-26
references.pmid: 12488232
references.citation: Transpl Int. 1998;11 Suppl 1:S168-70
references.pmid: 9664971
references.citation: Ann Surg. 2000 Aug;232(2):155-62
references.pmid: 10903590
references.citation: Ann Surg. 2005 Jul;242(1):133-9
references.pmid: 15973111
references.citation: Curr Opin Nephrol Hypertens. 2002 Jan;11(1):43-8
references.pmid: 11753086
references.citation: Am J Surg. 2001 Feb;181(2):160-6
references.pmid: 11425059
references.citation: Circulation. 1993 Mar;87(3):893-9
references.pmid: 7680290
references.citation: Transplantation. 1999 Apr 27;67(8):1128-32
references.pmid: 10232562
references.citation: Transplant Proc. 1991 Feb;23(1 Pt 2):1538-40
references.pmid: 1989281
references.citation: Surgery. 2003 Jan;133(1):81-90
references.pmid: 12563242
references.citation: Cardiovasc Res. 1995 Jun;29(6):782-8
references.pmid: 7656281
references.citation: J Biol Chem. 2001 Apr 13;276(15):11870-6
references.pmid: 11150293
references.citation: Circ Res. 1985 Feb;56(2):242-51
references.pmid: 3882259
references.citation: J Heart Lung Transplant. 1996 Dec;15(12):1258-67
references.pmid: 8981211
references.citation: Liver Transpl. 2005 Feb;11(2):196-202
references.pmid: 15666380
references.citation: Shock. 1997 Aug;8(2):86-94
references.pmid: 9261897
references.citation: Liver Transpl. 2000 Jan;6(1):3-20
references.pmid: 10648573
references.citation: Liver Transpl. 2004 Feb;10(2 Suppl 1):S53-7
references.pmid: 14762840
references.citation: Br Med J. 1968 Nov 30;4(5630):535-40
references.pmid: 4881063
references.citation: Br J Urol. 1997 Jun;79(6):842-7
references.pmid: 9202547
references.citation: Gastroenterology. 2003 Nov;125(5):1480-91
references.pmid: 14598265
references.citation: N Engl J Med. 2003 Feb 27;348(9):818-25
references.pmid: 12606737
references.citation: Hepatology. 2001 May;33(5):1073-9
references.pmid: 11343234
references.citation: Gastroenterology. 2003 Sep;125(3):917-36
references.pmid: 12949736
references.citation: Surgery. 2001 Jun;129(6):664-7
references.pmid: 11391362
references.citation: Liver Transpl. 2004 Feb;10(2):244-7
references.pmid: 14762862
references.citation: Gastroenterology. 1985 Jun;88(6):1812-7
references.pmid: 3888769
references.citation: Transplantation. 2003 May 27;75(10):1683-7
references.pmid: 12777856
references.citation: Exp Physiol. 2000 Nov;85(6):819-27
references.pmid: 11187976
references.citation: Life Sci. 2001 May 25;69(1):1-15
references.pmid: 11411799