Ischaemic preconditioning of the graft in adult living related right lobe liver transplantation: impact on ischaemia-reperfusion injury and clinical relevance.
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.
Andreani
Paola
P
Département de Chirurgie Hépato-Biliaire, Centre Hépato-Biliaire, IFR 89.9, France.
Hoti
Emir
E
de la Serna
Sofia
S
degli Esposti
Davide
D
Sebagh
Mylène
M
Lemoine
Antoinette
A
Ichai
Philippe
P
Saliba
Fauzi
F
Castaing
Denis
D
Azoulay
Daniel
D
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
D015415:Biomarkers; D001219:Aspartate Aminotransferases
Radiology. 1981 Nov;141(2):525-7
6974875
Hepatology. 2000 Mar;31(3):577-80
10706545
Transplantation. 2001 Mar 27;71(6):812-4
11330547
BJU Int. 2000 Jun;85(9):1007-13
10848685
J Lab Clin Med. 1996 Sep;128(3):251-8
8783632
Clin Transplant. 2010 May-Jun;24(3):334-40
19712082
Surg Gynecol Obstet. 1992 Sep;175(3):270-2
1514163
Hepatology. 1997 Mar;25(3):658-63
9049215
Transplantation. 2001 Sep 15;72(5):861-8
11571451
Transplantation. 1997 Nov 15;64(9):1300-6
9371672
Ann Intern Med. 1979 Feb;90(2):185-7
443650
Ann Surg. 2003 Feb;237(2):180-5
12560775
Liver Transpl. 2001 Apr;7(4):292-9
11303287
Surg Today. 2002;32(1):1-12
11871810
J Cereb Blood Flow Metab. 2002 Nov;22(11):1283-96
12439285
Ann Surg. 2003 Dec;238(6):843-50; discussion 851-2
14631221
Liver Transpl. 2004 Feb;10(2):264-72
14762865
Liver Transpl. 2000 Nov;6(6 Suppl 2):S66-72
11084089
Surgery. 2004 Feb;135(2):203-14
14739856
Circulation. 1986 Nov;74(5):1124-36
3769170
Transplantation. 1994 Apr 15;57(7):1127-30
8165712
FASEB J. 2005 Oct;19(12):1617-26
16195370
Ren Fail. 1997 Jan;19(1):47-60
9044451
Ren Fail. 1999 Mar;21(2):135-45
10088174
Arch Surg. 2001 Nov;136(11):1263-6
11695970
Transplant Proc. 1993 Dec;25(6):3303-4
8266552
Am J Physiol Gastrointest Liver Physiol. 2003 Jan;284(1):G15-26
12488232
Transpl Int. 1998;11 Suppl 1:S168-70
9664971
Ann Surg. 2000 Aug;232(2):155-62
10903590
Ann Surg. 2005 Jul;242(1):133-9
15973111
Curr Opin Nephrol Hypertens. 2002 Jan;11(1):43-8
11753086
Am J Surg. 2001 Feb;181(2):160-6
11425059
Circulation. 1993 Mar;87(3):893-9
7680290
Transplantation. 1999 Apr 27;67(8):1128-32
10232562
Transplant Proc. 1991 Feb;23(1 Pt 2):1538-40
1989281
Surgery. 2003 Jan;133(1):81-90
12563242
Cardiovasc Res. 1995 Jun;29(6):782-8
7656281
J Biol Chem. 2001 Apr 13;276(15):11870-6
11150293
Circ Res. 1985 Feb;56(2):242-51
3882259
J Heart Lung Transplant. 1996 Dec;15(12):1258-67
8981211
Liver Transpl. 2005 Feb;11(2):196-202
15666380
Shock. 1997 Aug;8(2):86-94
9261897
Liver Transpl. 2000 Jan;6(1):3-20
10648573
Liver Transpl. 2004 Feb;10(2 Suppl 1):S53-7
14762840
Br Med J. 1968 Nov 30;4(5630):535-40
4881063
Br J Urol. 1997 Jun;79(6):842-7
9202547
Gastroenterology. 2003 Nov;125(5):1480-91
14598265
N Engl J Med. 2003 Feb 27;348(9):818-25
12606737
Hepatology. 2001 May;33(5):1073-9
11343234
Gastroenterology. 2003 Sep;125(3):917-36
12949736
Surgery. 2001 Jun;129(6):664-7
11391362
Liver Transpl. 2004 Feb;10(2):244-7
14762862
Gastroenterology. 1985 Jun;88(6):1812-7
3888769
Transplantation. 2003 May 27;75(10):1683-7
12777856
Exp Physiol. 2000 Nov;85(6):819-27
11187976
Life Sci. 2001 May 25;69(1):1-15
11411799