The New Strategy of Liver Transplantation From Marginal Donors Using Serine Protease Inhibitor

Abstract

Poster Abstracts 5 4 8 WEDNESDAY Supplement to Transplantation July 27, 2008, Volume 86 Number 2Sfor E-1 and E-2) and 14 (p< 0,0001 for E-1 and E-2) days, if compared to the controls. After 28 days the effect remained non-signifi cant, although average values were still lower. Hydroxyproline content and concentration were measured after 7 days and show a dose dependent decline. The difference between the experimental groups and control group was signifi cant (p< 0,05), the difference between E-1 and E-2 for ileum and colon anastomoses was not signifi cant. Histological parameters did not show any apparent differences between groups. Fascial wounds were less strong in both experimental groups at all three points measured. Conclusion: Everolimus interferes with wound repair. Fibroblast collagen synthesis and deposition of new collagen fi bers are essential to the proliferation phase of normal wound repair. Most likely, impaired cellular proliferation is responsible for the effect seen here. Even after 4 weeks, wound strength appears to remain below normal. Such a prolonged effect may have clinical consequences and cause surgical morbidity. The possibility of prevention of surgical complications, or diminishing the negative effect, is an exciting incentive for further investigation.

Liver transplantation: Issues for the next 20 years

“…Identifications of biomarkers that specifically reflect viability of harvested NHBD livers need to be identified 51 . Pharmacological manipulation or pretreatment with serine protease inhibitors has been shown to minimize the damage caused by warm ischemia in experimental models 52,53 . Addition of anti‐thrombolytic drugs (Streptokinase) to the perfusion solutions has also been shown in both animal studies and renal transplantation, to improve the microcirculation 54–57 but there is little evidence for its value in liver transplantation.…”

“…51 Pharmacological manipulation or pretreatment with serine protease inhibitors has been shown to minimize the damage caused by warm ischemia in experimental models. 52,53 Addition of antithrombolytic drugs (Streptokinase) to the perfusion solutions has also been shown in both animal studies and renal transplantation, to improve the microcirculation [54][55][56][57] but there is little evidence for its value in liver transplantation. Pharmacological manipulation of the donor prior to cardiac death within an ethically acceptable framework may result in better outcomes.…”

Soluble Thrombomodulin Ameliorates Ischemia-Reperfusion Injury of Liver Grafts by Modulating the Proinflammatory Role of High-Mobility Group Box 1

“…Previous studies have reported that liver grafts remain suitable for transplantation purposes for 30-60 min after warm ischemia in the absence of agonal conditions (Takada et al 1997;Monbaliu et al 2005). However, another study reported that no liver-transplant recipients survived for 24 h in cases where the grafts underwent 30 min of warm ischemia with agonal conditions (Miyagi et al 2009). Considering these past findings, we set the warm ischemia time to 30 min and used an IPRL model, which has been widely used to evaluate graft viability after liver transplantation (Bessems et al 2006).…”