title: Ischemic Postconditioning of the Liver Graft in Adult Liver Transplantation.
abstract: BACKGROUND
  Ischemia-reperfusion (I/R) injury is the main cause of graft failure in liver transplantation (LT). Ischemic postconditioning (IPo) has shown to be beneficial against I/R injury. Our objective was to compare the results of LT with or without IPo.
  
  
  METHODS
  One hundred patients undergoing LT alternatively received IPo or not. At the time of arterial reperfusion, IPo consisted of three 1-minute arterial occlusions, interspersed with 1-minute reperfusion pauses. The primary endpoint was postoperative aspartate aminotransferase (AST) peak value; early graft dysfunction and histological I/R injury were secondary endpoints.
  
  
  RESULTS
  Median postoperative AST peak values was similar in both groups (426 vs 463 IU/L, P = 0.21); no difference was found in other postoperative liver function tests. In the IPo group, fewer grafts presented severe histological I/R injury (12% vs 28%; P = 0.029). Ischemic postconditioning did not induce changes in cellular apoptosis but triggered autophagy in periportal areas. Independent predictors of severe I/R injury were IPo (odds ratio, 0.20; P = 0.008) and arterial warm ischemia duration (odds ratio, 1.05; P = 0.008). Early graft dysfunction rate was similar in both groups (20% versus 26%, P = 0.47) and was associated with severe histological I/R injury and longer cold ischemia. Morbidity, mortality, and 1-year graft and patient survival were similar in both groups.
  
  
  CONCLUSIONS
  Ischemic postconditioning did not influence postoperative AST peak values or other liver function tests. However, our results showed a better tolerance to I/R injury on histological findings of grafts receiving IPo. Future studies are necessary to optimize the IPo protocol in LT, to clarify its clinical impact, and to deepen the molecular understanding.
authors: 1 Dipartimento di Scienze Medico-Chirurgiche e Medicina Traslazionale, Università degli Studi di Roma La Sapienza, Rome, Italy. 2 AP-HP Hôpital Paul Brousse-Centre Hépatobiliaire, Villejuif, France. 3 INSERM UMR-S 1004, Université Paris Sud, Villejuif, France. 4 AP-HP Hôpital Paul Brousse, Biochimie et Oncogénétique, Villejuif, France. 5 AP-HP Hôpital Paul Brousse, Centre Hépatobiliaire, Villejuif, France. 6 INSERM UMR-S 785, Université Paris Sud, Villejuif, France. 7 AP-HP Hôpital Henri Mondor, Service de Chirurgie Digestive Hépatobiliaire, Creteil, France. 8 INSERM U 955, Université Paris Est, Créteil, France.
authors: Luana
authors: L
authors: Ricca
authors: Antoinette
authors: A
authors: Lemoine
authors: François
authors: F
authors: Cauchy
authors: Jocelyne
authors: J
authors: Hamelin
authors: Mylène
authors: M
authors: Sebagh
authors: Davide Degli
authors: DD
authors: Esposti
authors: Chady
authors: C
authors: Salloum
authors: Eric
authors: E
authors: Vibert
authors: Genoveffa
authors: G
authors: Balducci
authors: Daniel
authors: D
authors: Azoulay
mesh_terms: D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D050377:Cold Ischemia / Q000009:adverse effects; D005260:Female; D005602:France; D006085:Graft Survival; D006801:Humans; D057775:Ischemic Postconditioning / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D055031:Primary Graft Dysfunction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases