Predictive value of intraoperative biopsies and liver function tests for preservation injury in orthotopic liver transplantation

Abstract

and ALT values are not useful in the assessment of PI. Eighty liver allografts were studied to determine the (HEPATOLOGY 1997;25:184-189 .) predictive value of intraoperative biopsies and postoperative liver function tests for the development of preservation injury (PI). Peak transaminase (aspartate transaminase [AST] and alanine transaminase [ALT])Graft viability is of the utmost importance for successful and prothrombin time (PT) values achieved by each pa-orthotopic liver transplantation. Virtually all liver allografts tient during postoperative days (POD) 1 through 7 were are injured during transplantation, either as a result of determined. PI in day 0 preperfusion biopsies (0Pre) (ob-events leading to donor death, donor life support, or during tained immediately before implantation) and postperfu-the process of allograft extraction, cold preservation, implansion biopsies (0Post) (obtained immediately after revas-tation, hypoxic rewarming, and reperfusion. Allograft injury cularization) was categorized by histological criteria as resulting from the transplantation process is commonly represent or absent. PI in biopsies taken during POD 2 ferred to as preservation injury (PI). Preservation injury is through 14 was histologically graded as either moderate-a major contributor to primary allograft dysfunction, a term to-severe, mild, or absent. Of the 80 allografts, 8 were encompassing both primary nonfunction, defined as complete omitted because of primary nonfunction or postopera-allograft failure in the absence of apparent technical or imtive complications. 0Pre and 0Post biopsies were avail-munologic complications, and initial poor function (IPF), deable on 25 of 72 (35%) and 69 of 72 (96%) allografts, respec-fined as borderline graft function immediately after transtively. Only 2 (8%) of the 0Pre biopsies showed plantation. histological PI compared with 48 (70%) of the 0Post biop-Several studies have attempted to identify donor, intraopsies. Fifty-nine patients were biopsied between POD 2 erative, and recipient factors predictive of primary allograft through 14. Of these, 15, 28, and 16 patients developed dysfunction. Primary dysfunction has been consistently assomoderate-to-severe, mild, or no evidence of PI, respec-ciated with prolonged cold and warm ischemia, severe macrotively. The presence of PI in the 0Post biopsy strongly vesicular steatosis, ABO blood group incompatibility, and docorrelated with the development of PI during POD 2 nor age over 50 years. [1][2][3][4][5][6][7][8][9][10][11][12] Additional risk factors include through 14 (P õ .0005). Peak AST and ALT values in retransplantation, markedly elevated donor transaminase patients with moderate-to-severe PI on POD 2 through levels, the use of pressors in the donor, and the use of re-14 were significantly elevated compared with those pa-duced-size liver grafts. 1-12 Despite efforts to avoid using donor tients with either mild (P Å .01 and .03) or no PI (P Å .02 organs with these and other potentially adverse variables, and .006). Because of ext...

Liver Transplantation After Ex Vivo Normothermic Machine Preservation: A Phase 1 (First-in-Man) Clinical Trial

“…Although the results in the 20 patients reported here showed no statistical difference in the primary outcome, with an important caveat regarding the small numbers, it suggests that NMP halves peak transaminase, a surrogate marker for graft function (20,21) and preservation injury (22,23). As noted above, the control group covered a longer time period than the intervention group to allow adequately matched control patients to be identified in the two liver transplant units concerned.…”

“…Matched control patients were identified as described above; to find two matched controls, preset criteria were extended in some cases, MELD was 12 in NMP versus 14 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) in matched controls (p = 0.55).…”

Postreperfusion biopsies are useful in predicting complications after liver transplantation

“…The severity of hepatocellular necrosis was graded as follows: 0, no necrosis; 1, focal necrosis with individual acidophilic cells; 2, confluent necrosis involving 2 to 3 adjacent hepatocytes; and 3, zonal necrosis with large areas of confluent necrosis involving the entire lobule. 2 Macrovesicular and microvesicular steatosis were judged as follows: mild, fat present in less than 30% of hepatocytes; moderate, fat infiltration of 31% to 60%; and severe, fat infiltration greater than 61% of hepatocytes. The presence of fibrotic bridges, cholestatic changes, sinusoidal dilatation, and glucogenized nuclei was also recorded.…”

“…However, few studies have analyzed the predictive value of postreperfusion liver biopsies for the development of graft dysfunction and late complications. Kakizoe et al 1 and Gaffey et al 2 showed that necrosis and neutrophilic inflammation in intraoperative postreperfusion biopsy specimen were predictive of graft initial poor function (IPF). Other studies have shown that sinusoidal cells are damaged during cold ischemia time, and warm ischemiainjures endothelial cells.…”

Liver glutathione depletion after preservation and reperfusion in human liver transplantation

“…However, there is scarce information about GSH and GSSG liver concentrations after cold storage and reperfusion in clinical OLT. Moreover, only few reports have correlated donor risk factors with histopathological reperfusion injury found in the liver tissue 7,8 . The objectives were to evaluate GSH and GSSG liver concentrations after cold storage and reperfusion in optimal and suboptimal grafts and also the initial histopathological injury and function of the grafts.…”