title: Early markers of reperfusion injury after liver transplantation: association with primary dysfunction.
abstract: BACKGROUND
  In patients with end-stage liver disease, liver transplantation is the only available curative treatment. Although the outcome and quality of life in the patients have improved over the past decades, primary dys- or nonfunction (PDF/PNF) can occur. Early detection of PDF and PNF is crucial and could lead to individual therapies. This study was designed to identify early markers of reperfusion injury and PDF in liver biopsies taken during the first hour after reperfusion.
  
  
  METHODS
  Biopsies from donor livers were prospectively taken as a routine during the first hour after reperfusion. Recipient data, transaminases and outcome were routinely monitored. In total, 10 biopsy specimens taken from patients with 90-day mortality and PDF, and patients with long-term survival but without PDF were used for DNA microarrays. Markers that were significantly up- or down-regulated in the microarray were verified using quantitative real-time PCR.
  
  
  RESULTS
  Age, indications and labMELD score were similar in both groups. Peak-transaminases during the first week after transplantation were significantly different in the two groups. In total, 20 differentially regulated markers that correlated to PDF were identified using microarray analysis and verified with quantitative real-time PCR.
  
  
  CONCLUSIONS
  The markers identified in this study could predict PDF at a very early time point and might point to interventions that ameliorate reperfusion injury and thus prevent PDF. Identification of patients and organs at risk might lead to individualized therapies and could ultimately improve outcome.
authors.affiliation: Department of General and Transplant Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany. Peter.Schemmer@med.uni-heidelberg.de.
authors.forename: Helge
authors.initials: H
authors.lastname: Bruns
authors.forename: Jan
authors.initials: J
authors.lastname: Heil
authors.forename: Daniel
authors.initials: D
authors.lastname: Schultze
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Saeedi
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D042241:Early Diagnosis; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D020869:Gene Expression Profiling / Q000379:methods; D005819:Genetic Markers; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D020411:Oligonucleotide Array Sequence Analysis; D011237:Predictive Value of Tests; D055031:Primary Graft Dysfunction / Q000175:diagnosis / Q000235:genetics* / Q000401:mortality / Q000503:physiopathology; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005819:Genetic Markers