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Warm Ischemic Injury Is Reflected in the Release of Injury Markers during Cold Preservation of the Human Liver
BACKGROUND: Liver transplantation plays a pivotal role in the treatment of patients with end-stage liver disease. Despite excellent outcomes, the field is strained by a severe shortage of viable liver grafts. To meet high demands, attempts are made to increase the use of suboptimal livers by both pr...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378972/ https://www.ncbi.nlm.nih.gov/pubmed/25822248 http://dx.doi.org/10.1371/journal.pone.0123421 |
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author | Bruinsma, Bote G. Wu, Wilson Ozer, Sinan Farmer, Adam Markmann, James F. Yeh, Heidi Uygun, Korkut |
author_facet | Bruinsma, Bote G. Wu, Wilson Ozer, Sinan Farmer, Adam Markmann, James F. Yeh, Heidi Uygun, Korkut |
author_sort | Bruinsma, Bote G. |
collection | PubMed |
description | BACKGROUND: Liver transplantation plays a pivotal role in the treatment of patients with end-stage liver disease. Despite excellent outcomes, the field is strained by a severe shortage of viable liver grafts. To meet high demands, attempts are made to increase the use of suboptimal livers by both pretransplant recovery and assessment of donor livers. Here we aim to assess hepatic injury in the measurement of routine markers in the post-ischemic flush effluent of discarded human liver with a wide warm ischemic range. METHODS: Six human livers discarded for transplantation with variable warm and cold ischemia times were flushed at the end of preservation. The liver grafts were flushed with NaCl or Lactated Ringer’s, 2 L through the portal vein and 1 L through the hepatic artery. The vena caval effluent was sampled and analyzed for biochemical markers of injury; lactate dehydrogenase (LDH), alanine transaminase (ALT), and alkaline phosphatase (ALP). Liver tissue biopsies were analyzed for ATP content and histologically (H&E) examined. RESULTS: The duration of warm ischemia in the six livers correlated significantly to the concentration of LDH, ALT, and ALP in the effluent from the portal vein flush. No correlation was found with cold ischemia time. Tissue ATP content at the end of preservation correlated very strongly with the concentration of ALP in the arterial effluent (P<0.0007, R(2) = 0.96). CONCLUSION: Biochemical injury markers released during the cold preservation period were reflective of the duration of warm ischemic injury sustained prior to release of the markers, as well as the hepatic energy status. As such, assessment of the flush effluent at the end of cold preservation may be a useful tool in evaluating suboptimal livers prior to transplantation, particularly in situations with undeterminable ischemic durations. |
format | Online Article Text |
id | pubmed-4378972 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-43789722015-04-09 Warm Ischemic Injury Is Reflected in the Release of Injury Markers during Cold Preservation of the Human Liver Bruinsma, Bote G. Wu, Wilson Ozer, Sinan Farmer, Adam Markmann, James F. Yeh, Heidi Uygun, Korkut PLoS One Research Article BACKGROUND: Liver transplantation plays a pivotal role in the treatment of patients with end-stage liver disease. Despite excellent outcomes, the field is strained by a severe shortage of viable liver grafts. To meet high demands, attempts are made to increase the use of suboptimal livers by both pretransplant recovery and assessment of donor livers. Here we aim to assess hepatic injury in the measurement of routine markers in the post-ischemic flush effluent of discarded human liver with a wide warm ischemic range. METHODS: Six human livers discarded for transplantation with variable warm and cold ischemia times were flushed at the end of preservation. The liver grafts were flushed with NaCl or Lactated Ringer’s, 2 L through the portal vein and 1 L through the hepatic artery. The vena caval effluent was sampled and analyzed for biochemical markers of injury; lactate dehydrogenase (LDH), alanine transaminase (ALT), and alkaline phosphatase (ALP). Liver tissue biopsies were analyzed for ATP content and histologically (H&E) examined. RESULTS: The duration of warm ischemia in the six livers correlated significantly to the concentration of LDH, ALT, and ALP in the effluent from the portal vein flush. No correlation was found with cold ischemia time. Tissue ATP content at the end of preservation correlated very strongly with the concentration of ALP in the arterial effluent (P<0.0007, R(2) = 0.96). CONCLUSION: Biochemical injury markers released during the cold preservation period were reflective of the duration of warm ischemic injury sustained prior to release of the markers, as well as the hepatic energy status. As such, assessment of the flush effluent at the end of cold preservation may be a useful tool in evaluating suboptimal livers prior to transplantation, particularly in situations with undeterminable ischemic durations. Public Library of Science 2015-03-30 /pmc/articles/PMC4378972/ /pubmed/25822248 http://dx.doi.org/10.1371/journal.pone.0123421 Text en © 2015 Bruinsma et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Bruinsma, Bote G. Wu, Wilson Ozer, Sinan Farmer, Adam Markmann, James F. Yeh, Heidi Uygun, Korkut Warm Ischemic Injury Is Reflected in the Release of Injury Markers during Cold Preservation of the Human Liver |
title | Warm Ischemic Injury Is Reflected in the Release of Injury Markers during Cold Preservation of the Human Liver |
title_full | Warm Ischemic Injury Is Reflected in the Release of Injury Markers during Cold Preservation of the Human Liver |
title_fullStr | Warm Ischemic Injury Is Reflected in the Release of Injury Markers during Cold Preservation of the Human Liver |
title_full_unstemmed | Warm Ischemic Injury Is Reflected in the Release of Injury Markers during Cold Preservation of the Human Liver |
title_short | Warm Ischemic Injury Is Reflected in the Release of Injury Markers during Cold Preservation of the Human Liver |
title_sort | warm ischemic injury is reflected in the release of injury markers during cold preservation of the human liver |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378972/ https://www.ncbi.nlm.nih.gov/pubmed/25822248 http://dx.doi.org/10.1371/journal.pone.0123421 |
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