Effect of ischemic preconditioning in whole liver transplantation from deceased donors. A pilot study

✍ Scribed by Matteo Cescon; Gian Luca Grazi; Alberto Grassi; Matteo Ravaioli; Gaetano Vetrone; Giorgio Ercolani; Giovanni Varotti; Antonietta D'Errico; Giorgio Ballardini; Antonio Daniele Pinna

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 162 KB
• Volume: 12
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20640

✦ Synopsis

The effect of ischemic preconditioning (IPC) in orthotopic liver transplantation (OLT) has not yet been clarified. We performed a pilot study to evaluate the effects of IPC in OLT by comparing the outcomes of recipients of grafts from deceased donors randomly assigned to receive (IPCϩ group, n ϭ 23) or not (IPCϪ group, n ϭ 24) IPC (10-min ischemia ϩ 15-min reperfusion). In 10 cases in the IPCϩ group and in 12 in the IPCϪ group, the expression of inducible nitric oxide synthase (iNOS), neutrophil infiltration, and hepatocellular apoptosis were tested by immunohistochemistry in prereperfusion and postreperfusion biopsies. Median aspartate aminotransferase (AST) levels were lower in the IPCϩ group vs. the IPCϪ group on postoperative days 1 and 2 (398 vs. 1,234 U/L, P ϭ 0.002; and 283 vs. 685 U/L, P ϭ 0.009). Alanine aminotransferases were lower in the IPCϩ vs. the IPCϪ group on postoperative days 1, 2, and 3 (333 vs. 934 U/L, P ϭ 0.016; 492 vs. 1,040 U/L, P ϭ 0.008; and 386 vs. 735 U/L, P ϭ 0.022). Bilirubin levels and prothrombin activity throughout the first 3 postoperative weeks, incidence of graft nonfunction and graft and patient survival rates were similar between groups. Prereperfusion and postreperfusion immunohistochemical parameters did not differ between groups. iNOS was higher postreperfusion vs. prereperfusion in the IPCϪ group (P ϭ 0.008). Neutrophil infiltration was higher postreperfusion vs. prereperfusion in both groups (IPCϩ, P ϭ 0.007; IPCϪ, P ϭ 0.003). Prereperfusion and postreperfusion apoptosis was minimal in both groups. In conclusion, IPC reduced ischemia/reperfusion injury through a decrease of hepatocellular necrosis, but it showed no clinical benefits.