DAMAGE PARAMETERS FOR PERI- AND POSTOPERATIVE ASSESSMENT OF TRANSPLANT LIVERS
Frank Meyer*1, Hans Lippert3, Zuhir Halloul2
1Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital of Magdeburg, Magdeburg, Germany; 2Division of Vascular Surgery, Dept. of General, Abdominal, Vascular and Transplant Surgery, University Hospital of Magdeburg, Magdeburg, Germany; 3Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany
The success of standardized liver transplantation bases on substantial advances in surgical techniques and an optimized, patient-adapted immunosuppressive therapy. The use of cadaveric organs is influenced by i) a (possibly short) organ transfer, ii) a (possibly minimized) ischemia effect by a lowered organ temperature with effective solutions for tissue conservation, such as HTK /UW solutions, and iii) reperfusion effects (by oxidative stress).
Aim: To assess quality of transplanted liver organs by simply determined parameters, already started during surgical intervention.
Method: In all consecutive patients, systematic blood samples were withdrawn in a perioperative setting of liver transplantation (-1h; 0; +1/+6h; +1/+3/+7d) and liver rinsing blood fractions during reperfusion phase after vascular anastomosis (-1h/0/+1h) were obtained and analyzed: 1) AST/ALT/GLDH; 2) MDA/protein carbonyle each correlating to parenchymal damage and cold/warm ischemia time (CIT/WIT); 3) postoperative factors V/ATIII.
Results: From 1995-2009, 75 patients were enrolled (finally 60 with a completely analyzed spectrum of parameters). The rinsing blood was suitable to characterize damage of liver parenchyma/oxidative stress. CIT/WIT were in a short time frame, which was defined by the transplantation management and the standardized surgical technique - no strong correlations of damage parameters and time periods of ischemia. Oxidative-stress parameters showed only slight alterations/low correlations to other parameters - therefore, a causal association of ischemia/reperfusion, oxidative stress and cell damage can not be derived (only between CIT and AST). Obviously, the solutions for organ conservation provide an effective antioxidative protection. With regard to the impact of ischemia onto the transplanted organ, it was found that time if ischemia and GLDH correlated during the mid-term postoperative course (supported by the fact that GLDH is a suitable liver-specific laboratory parameter for assessment of damage).
Discussion: Explantation-caused liver perfusion disturbances provoke a potential parenchymal damage, which becomes relevant by the persisting ischemia during organ transfer. During reperfusion phase, damage events occur, which lead to and manifest damage of liver parenchyma. The re-established metabolic function influences outcome of the transplant recipients.
Conclusion: Ischemia-reperfusion damage bases on oxidative stress phenomenons. The extent of parenchymal damage can be quantified by analysis of the initial rinsing blood fractions. However, the advanced standardization did not lead to indicative courses of damage. During the establishing process of novel parameters to assess quality of liver transplantation, rinsing blood can be considered a suitable material for analysis and the presented laboratory parameter profile appears feasible and well-proven.
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