Abstracts
2001 Digestive Disease Week

# 2445 Soluble Adhesion Molecules (sICAM-1 and sVCAM-1) in liver transplantation -Bbeneficial or Deleterious Effects on Graft Function?
Martin Schenk, Annette Zipfel, Oliver Kinder, Werner Lauchart, Horst D Becker, Richard Viebahn, Tuebingen, Germany

The expression of adhesion molecules on endothelial tissues is a fundamental step in immunological activation leading to the dysfunction of a liver graft. Caused either by shearing forces or by active secretion, beside of the membranous form, soluble forms (sICAM-1, sVCAM-1) are found in the serum. In this study the role of these molecules was evaluated in terms of beneficial or deleterious effects on graft function in clinical liver transplantation (LTX). In a series of 72 LTX the concentrations of sICAM-1 and sVCAM-1 were determined pre- (incl. 52 donor sera), intra- and postoperatively in the serum by an ELISA procedure. Graft function rate was analyzed during 100 days post-TX according to the Kaplan-Maier method. The function rate of grafts from donors with sICAM-1 concentrations above 230 ng/ml (n = 35) was 83% compared to 47% from donors (n = 17) below that threshold (p = 0.003). No correlation to the sVCAM-1 concentration in the donor was found. Like in the donor, high sICAM-1 levels in the recipient before TX resulted in an improved graft function rate (£ 1100 ng/ml: 54%, n = 41; > 1100 ng/ml: 91%, n = 32). An additive effect was observed by combining the results of donor and recipient sICAM-1 levels. Elevated levels (> 1100 ng/ml) of sVCAM-1 in the recipient before TX also had a less significant but also positive impact on graft function (p = 0.04). Additive effects of sICAM-1 and sVCAM-1 in the recipient were observed as well. In the post-operative course an increase of ICAM-1 levels above 1.5-fold the level before TX was observed in the context of a bad function prognosis (63% vs. 90%; p = 0.005). The intra- and post-operative levels of sVCAM-1 were strongly suppressed by the intraoperative administration of pentoxifylline - without a correlation to the graft function rate. It is concluded that high levels of soluble adhesion molecules (especially sICAM-1) in the donor as well as in the recipient indicate a protective environment for liver grafts. However, these findings cannot be generalized: The postoperatively fast increasing levels of sICAM-1 in the context of deleterious influences might also reflect the beginning of an immunological activation.