Ischemic Preconditioning (IP) of the Liver as a Safe and Protective Technique against Ischemia/Reperfusion Injury (IRI)

• Published in: American journal of transplantation Vol. 9; no. 7; pp. 1629 - 1639
• Main Authors: Franchello, A., Gilbo, N., David, E., Ricchiuti, A., Romagnoli, R., Cerutti, E., Salizzoni, M.
• Format: Journal Article Web Resource
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.07.2009; Wiley
• Subjects: Adult; Aged; alanine aminotransferase; alanine aminotransferase blood level; Alanine Transaminase; Alanine Transaminase - blood; apoptosis; aspartate aminotransferase; aspartate aminotransferase blood level; Aspartate Aminotransferases; Aspartate Aminotransferases - blood; bile; bilirubin; blood culture; cell activation; cell swelling; Chirurgie; clinical article; clinical trial; controlled clinical trial; controlled study; cyclosporin; fatty liver; Female; graft rejection; Graft Survival; histology; human; Human health sciences; Humans; infection; international normalized ratio; Ischemia/reperfusion injury; Ischemic preconditioning; Ischemic Preconditioning - methods; lactic acid; Liver; Liver - blood supply; Liver - injuries; Liver - physiology; liver biopsy; liver graft; liver ischemia; liver necrosis; liver protection; Liver transplantation; Liver Transplantation - methods; Liver Transplantation - physiology; Male; Marginal graft; Middle Aged; neutrophil chemotaxis; priority journal; randomized controlled trial; Reperfusion Injury; Reperfusion Injury - prevention & control; risk assessment; Sciences de la santé humaine; scoring system; Surgery; surgical technique; tacrolimus; Tissue and Organ Harvesting; Tissue and Organ Harvesting - methods; Tissue Donors
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/j.1600-6143.2009.02680.x

The aim of the study was to evaluate safety and efficacy of IP in LT, particularly in marginal grafts. From 2007 to 2008, 75 LT donors were randomized to receive IP (IP+) or not (IP–). Considering the graft quality, we divided the main groups in two subgroups (marg+/marg–). IP was performed by 10‐min inflow occlusion (Pringle maneuver utilizing a toruniquet). Donor variables considered were gender, age, AST/ALT, ischemia time and steatosis. Recipient variables were gender, age, indication to LT and MELD/CHILD/UNOS score. AST/ALT levels, INR, bilirubin, lactic acid, bile output on postoperative days 1, 3 and 7 were evaluated. Histological analysis was performed evaluating necrosis/steatosis, hepatocyte swelling, PMN infiltration and councilman bodies. Thirty patients received IP+ liver. No differences were seen between groups considering recipient and donor variables. Liver function and AST/ALT levels showed no significant differences between the main two groups. Marginal IP+ showed lower AST levels on day1 compared with untreated marginal livers (936.35 vs. 1268.23; p = 0.026). IP+ livers showed a significant reduction of moderate‐severe hepatocyte swelling (33.3% vs. 65.9%; p = 0.043). IP+ patients had a significant reduction of positive early microbiological investigations (36.7% vs. 57.1%; p = 0.042). In our experience IP was safe also in marginal donors, showing a protective role against IRI. This prospective randomized study showed the safety and efficacy of ischemic preconditioning in liver transplantation, evaluating its correlation to clinical and histological improvement of both optimal and marginal preconditioned grafts.