Ischemia-reperfusion injury and its relationship with early allograft dysfunction in liver transplant patients

Abstract

Ischemia‐reperfusion injury (IRI) is believed to contribute to graft dysfunction after liver transplantation (LT). However, studies on IRI and the impact of early allograft dysfunction (EAD) in IRI grafts are limited. Histological IRI was graded in 506 grafts from patients who had undergone LT and classified based on IRI severity (no, minimal, mild, moderate, and severe). Of the 506 grafts, 87.4% had IRI (no: 12.6%, minimal: 38.1%, mild: 35.4%, moderate: 13.0%, and severe: 0.8%). IRI severity correlated with the incidence of EAD and graft survival at 6 months. Longer cold/warm ischemia time, recipient/donor hypertension, and having a male donor were identified as independent risk factors for moderate to severe IRI. Among 70 grafts with moderate to severe IRI, 42.9% of grafts developed EAD, and grafts with EAD had significantly inferior survival compared to grafts without EAD. Longer cold ischemia time and large droplet macrovesicular steatosis (≥20%) were identified as independent risk factors for EAD. Our study demonstrated that increased IRI severity was correlated with inferior short‐term graft outcomes. Careful consideration of IRI risk factors during donor‐recipient matching may assist in optimizing graft utilization and LT outcomes. Furthermore, identification of risk factors of IRI‐associated EAD may guide patient management and possible timely graft replacement.

The Role of Mitochondria in Liver Ischemia‐Reperfusion Injury: From Aspects of Mitochondrial Oxidative Stress, Mitochondrial Fission, Mitochondrial Membrane Permeable Transport Pore Formation, Mitophagy, and Mitochondria‐Related Protective Measures

“…Liver ischemia-reperfusion injury (IRI) occurs when blood supply is interrupted or sharply reduced, which is the main complication of liver operation, such as hepatectomy, liver transplantation, and trauma [ 1 , 2 ]. IRI has been reported to occur in a variety of organs: heart [ 3 , 4 ], kidney [ 5 ], brain [ 6 ], and lung [ 7 ], which has high morbidity and mortality worldwide.…”

Short recipient warm ischemia time improves outcomes in deceased donor liver transplantation

“…Warm ischemia of the liver graft is more deleterious to hepatocytes and high energy demands begin at 20⁰C of the liver core temperature [3]. It has been well reported that prolonged rWIT is associated with poor LT outcomes [4–6]. Rana et al.…”

Methods of Attenuating Ischemia-Reperfusion Injury in Liver Transplantation for Hepatocellular Carcinoma

“…Moderate/severe IRI was significantly associated with EAD occurrence ( p = 0.001). Moreover, increasing IRI severity was found to be a risk factor of a shorter 6-month graft survival ( p = 0.008) [ 79 ]. Similar conclusions were drawn by Bastos-Neves et al, after analyzing 602 liver transplantations.…”