Local liberation of cytokines during liver preservation

Gerlach, Jörg C.; Jörres, Achim; Nohr, Roland; Zeilinger, Katrin; Spatkowski, Gabriele; Neuhaus, P.

doi:10.1007/s001470050220

Cited by 13 publications

(7 citation statements)

References 32 publications

(2 reference statements)

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“…Those results confirmed the already published results comparing conventional antegrade reperfusion technique with the described reverse reperfusion method [9,12]. Experimental studies have shown that free oxygen radicals play a crucial role during reperfusion and are responsible for cytokinemediated cellular injuries [14,15]. Research till date has focused on ways to minimize the expression of those cytokines and various strategies were proposed [16], yet the ideal technique is still in research.…”

Section: Discussionsupporting

confidence: 88%

Incidence of ischemic type biliary lesions after liver transplantation using piggyback technique and retrograde reperfusion

et al. 2013

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Incidence of ischemic type biliary lesions after liver transplantation using piggyback technique 3 Summary Background With an incidence up to 20 % biliary complications in the first year after liver transplantation (LT), these are still the main problems following a successful transplantation (TX). Reperfusion in LT is done via an antegrade flow through the portal vein and the hepatic artery as a standard. Retrograde reperfusion via the caval vein has shown to reduce the rate of initial graft nonfunction after LT but increase biliary complications. Retrograde reperfusion in combination with piggyback technique is the standard technique for liver transplantation in our center. The aim of this study was to compare the rate of biliary complications after LT with retrograde reperfusion in combination with piggyback technique to the literature.Methods We reviewed our patient records in order to define the rate of biliary complications and patient survival after LT. Patients who were transplanted between 1998 and 2010 were included into the analysis; Ischemic type biliary lesions were defined as the necessity of an endoscopic cholangiography without the placement of a bile duct stent and without evidence of strictures due to anastomosis suture. Kaplan-Meier analysis was performed as time to event (stent) and survival analysis.Results One hundred ninety-eight patients were included, median age was 56 (22-71), indications for OLT were cryptogenic (43 %) and viral (40 %) cirrhosis or HCC (17 %). An ERCP was performed in 16 % of the included patients during the first year after LT, 6 % received a bile duct stent. Kaplan-Meier analysis showed a median 1 year survival of 83 % and a median 5 year survival of 73 % in the entire patient population.Conclusions Piggyback technique with retrograde reperfusion is a suitable method for LT in our center and did not show a higher prevalence of biliary complications with an excellent patient survival.

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Section: Discussionsupporting

confidence: 88%

Incidence of ischemic type biliary lesions after liver transplantation using piggyback technique and retrograde reperfusion

et al. 2013

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“…Times for ischemia, anastomosis and reperfusion are displayed in Table 1. During LTX 6,l (1-19) packed red cells, 10,7 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) fresh frozen plasma and 1,9 (1-6) packed platelets were used. A total of 3248,3 ml (1077-8500) were vacuumed off with the cellsaver device.…”

Section: Resultsmentioning

confidence: 99%

A single-center experience with retrograde-reperfusion in liver transplantation

et al. 2003

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Poor graft function secondary to injury by ischemia and reperfusion remains a major problem with regard to morbidity and mortality in clinical liver transplantation (LTX). Up to one fifth of patients suffer from poor initial liver function due to severe damage to hepatocytes. This situation leads either to primary nonfunction described in approximately 6% of LTX or to slow recovery. We present a new method of reperfusion during LTX. From July 1998 to July 2002, 42 LTX in 39 recipients, (10 female, 52 years old (26–70) were performed. LTX was carried out in piggy‐back technique. After completing the piggy‐back anastomosis, the caval vein was declamped immediately, and retrograde low pressure reperfusion of the graft with low oxygenated venous blood was established. Portal anastomosis was performed using a running suture. In order to provide optimal retrograde liver perfusion, no clamping of the donor portal vein was done. After completing portal anastomosis, the recipient portal vein was declamped immediately. During arterial anastomosis, the transplanted liver was antegradely perfused via the portal vein. After completing hepatic artery anastomosis, declamping of the hepatic artery was done and arterial perfusion started. No backtable or in‐situ‐flushing except the described reperfusion technique was performed. Forty‐two LTX in 39 recipients using piggy‐back technique and retrograde reperfusion via the caval vein followed by antegrade reperfusion via the portal vein were performed 38 out of 39 patients (97.44%) were alive and well at day 8 after LTX. One patient (2.56%) died of a pre‐existing portal vein thrombosis on day 2 after LTX. Three patients had to undergo retransplantation for hepatic artery thrombosis (7.14%). Liver enzymes, bilirubine, prothrombine time and AT III on day 1, 3, 5 and 8 after LTX showed favourable values. Median aspartate aminotransferase (ASAT) was 219 U/l on day 1 after LTX. One‐month survival rate was 95.23%, and 1‐year survival rate 87.88%. Two patients died of liver‐associated causes (5.12%). One patient died of a late hepatic artery thrombosis, and one more of rejection. No other severe case of rejection appeared. We can conclude that retrograde reperfusion might be highly sufficient method of removing perfusion fluid from the transplanted liver. Low pressure perfusion with low oxygenated blood might reduce the production of free oxygen radicals. Retrograde reperfusion via the caval vein and antegrade reperfusion via the portal vein seemed to lower postoperative liver enzyme values and to improve initial liver function after LTX.

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“…This allows dilution and removal of toxic end-products, delivery of metabolic substrates, antioxidants and colloids to maintain the microvascular tone and improve ATP availability on reperfusion (7)(8)(9)(10). HMP has seen an impressive increase in utilization for renal transplantation, with data showing superior early graft function and graft survival, as well as less graft injury in human kidney studies (2,11,12).…”

Section: Scs Atmentioning

confidence: 99%

Hypothermic Machine Preservation Reduces Molecular Markers of Ischemia/Reperfusion Injury in Human Liver Transplantation

Henry

Nachber

Tulipan

et al. 2012

American Journal of Transplantation

138

121

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Hypothermic machine perfusion (HMP) is in its infancyin clinical liver transplantation. Potential benefits include diminished preservation injury (PI) and improved graft function. Molecular data to date has been limited to extrapolation of animal studies. We analyzed liver tissue and serum collected during our Phase 1 trial of liver HMP. Grafts preserved with HMP were compared to static cold stored (SCS) transplant controls. Reverse transcription polymerase chain reaction (RT-PCR), immunohistochemistry and transmission electron microscopy (TEM) were performed on liver biopsies. Expression of inflammatory cytokines, adhesion molecules and chemokines, oxidation markers, apoptosis and acute phase proteins and the levels of CD68 positive macrophages in tissue sections were evaluated. RT-PCR of reperfusion biopsy samples in the SCS group showed high expression of inflammatory cytokines, adhesion molecules and chemokines, oxidative markers and acute phase proteins. This upregulation was significantly attenuated in livers that were preserved by HMP. Immunofluorescence showed larger numbers of CD68 positive macrophages in the SCS group when compared to the HMP group. TEM samples also revealed ultrastructural damage in the SCS group that was not seen in the HMP group. HMP significantly reduced proinflammatory cytokine expression, relieving the downstream activation of adhesion molecules and migration of leukocytes, including neutrophils and macrophages when compared to SCS controls.

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Local liberation of cytokines during liver preservation

Cited by 13 publications

References 32 publications

Incidence of ischemic type biliary lesions after liver transplantation using piggyback technique and retrograde reperfusion

Incidence of ischemic type biliary lesions after liver transplantation using piggyback technique and retrograde reperfusion

A single-center experience with retrograde-reperfusion in liver transplantation

Hypothermic Machine Preservation Reduces Molecular Markers of Ischemia/Reperfusion Injury in Human Liver Transplantation

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