Preservation and Reperfusion Injuries in Liver Allografts

Clavien, Pierre Alain; Harvey, P. R. C.; Strasberg, Steven M.

doi:10.1097/00007890-199205000-00001

Cited by 791 publications

(470 citation statements)

References 0 publications

Supporting

Mentioning

433

Contrasting

Unclassified

Order By: Relevance

“…These two stages of cytotoxicity correspond to the results obtained for nonparenchymal cells in the isolated perfused rat liver 7 and reflects the two major stages of transplantation injury in humans. 1 In the present study, we have found that cold storage in SLS solution affords as good a preservation of gross cell viability as does UW solution, whether during simple cold storage or after rewarming.…”

Section: Discussionsupporting

confidence: 54%

“…1 Despite improvements in cold preservation solutions, such as the commonly used University of Wisconsin (UW) solution, 2 initial graft nonfuction or dysfuction still remains problematic, accounting for 10% to 15% of liver graft failures. 1 There is thus room for further improvements in preservation conditions, especially because one of the most important factors for poor transplantation prognosis remains prolonged cold storage time. 3,4 Many studies have evaluated the relevance of several empirically derived components of the costly UW solution (Table 1), and the general consensus indicates that lactobionate is the key element to improve liver preservation as opposed to other organs, such as the heart, kidney, or lung.…”

confidence: 99%

“…5,6 Unlike other organs, transplantation injury in the liver is characterized by microcirculatory problems that are related mainly to the sensitivity of liver endothelial cells to cold preservation and rewarming. 1,5,7 Morphologically, they show retraction of cytoplasm (rounding up) during cold preservation that progresses toward loss of viability and denudation of the sinusoids after warm reperfusion. 7 Although hepatocytes appear to be the most resistant cell type to cold storage and rewarming according to morphological studies, 7 others, including our-selves, have shown that their metabolic and transport functions are perturbed.…”

confidence: 99%

See 2 more Smart Citations

Cytochrome P-450 content and activity after cold storage of rat hepatocytes in university of wisconsin and sodium-lactobionate-sucrose solutions

et al. 1999

View full text Add to dashboard Cite

We compared the capacity of University of Wisconsin (UW) and of sodium-lactobionate-sucrose (SLS) hypothermic preservation solutions to maintain the integrity of the hepatic cytochrome P-450-dependent mono-oxygenase system. Isolated rat hepatocytes were stored for 0, 10, 24, and 48 hours in UW or SLS solution and were subsequently cultured shortly at 37°C. Cell viability declined slightly but significantly in a timedependent manner during cold preservation in either UW or SLS solution, and warm culture exacerbated this effect. Total cytochrome P-450 declined gradually after cold preservation and warm culture to reach values of 70% and 52% of unstored controls in cells preserved for 24 and 48 hours in cold UW solution, respectively. Storage in cold SLS solution yielded a similar decrease to 79% and 59% of unstored controls for the equivalent preservation times. Cytochrome P-450 activity was assessed by the metabolism of theophylline after various cold preservation times in UW or SLS solutions. Production of the major metabolite 1,3-dimethyluric acid was not significantly affected by extended cold preservation periods in either UW or SLS solutions. Similarly, the amount of residual theophylline remained stable in all groups, suggesting that alternative metabolic routes were not modified. These studies show that cold preservation in SLS solution is as effective as that in UW solution in terms of cell viability, cytochrome P-450 content, and activity toward theophylline. In addition, the significant reduction in cytochrome P-450 in conjunction with unaffected theophylline disposition suggests that certain cytochrome P-450 isoforms are specifically damaged by cold preservation and rewarming.

show abstract

Section: Discussionsupporting

confidence: 54%

confidence: 99%

See 1 more Smart Citation

Cytochrome P-450 content and activity after cold storage of rat hepatocytes in university of wisconsin and sodium-lactobionate-sucrose solutions

et al. 1999

View full text Add to dashboard Cite

show abstract

“…3 Although the precise mechanism of ischemia-reperfusion injury has not been established, key mediators have been identified, including oxygen free radicals, 4 cytokines, 5 and adhesion molecules 6 that lead to capillary perfusion failure 7 with subsequent impairment of tissue oxygenation. Hepatic tissue oxygenation has been identified in rodents as an indicator of the severity of warm ischemia-reperfusion injury 8 and is of prognostic value for survival in liver transplantation.…”

confidence: 99%

Changes in tissue oxygenation of the porcine liver measured by near-infrared spectroscopy

et al. 1999

View full text Add to dashboard Cite

Near-infrared spectroscopy (NIRS) is a novel method for the measurement of tissue oxygenation and may have a role in monitoring liver oxygenation and viability. The aim of this study is to validate the application of NIRS for monitoring hepatic tissue oxygenation. Large Landrace pigs (n ‫؍‬ 12) underwent laparotomy and liver exposure. Total hepatic blood flow (THBF) was measured by the Transonic Medical Flowmeter system. NIRS probes were placed on the liver surface to continuously record changes in hepatic tissue oxyhemoglobin (HbO 2 ), deoxyhemoglobin (Hb), and the reduction-oxidation state of cytochrome oxidase (Cyt Ox). Reduction of hepatic tissue oxygenation was achieved by hepatic vascular inflow occlusion (n ‫؍‬ 6) or reduction of inspired oxygen (FIO 2 ; n ‫؍‬ 6). The THBF changes correlated significantly with hepatic HbO 2 (r ‫؍‬ 0.84; P F .001) and Cyt Ox (r ‫؍‬ 0.88; P F .001). With reduction of FIO 2 , a significant correlation was found between arterial oxygen saturation and hepatic HbO 2 and Hb (r ‫؍‬ 0.99 and r ‫؍‬ ؊0.99, respectively; P F .0001). NIRS measurement of liver parenchymal oxygenation correlates well with changes in liver blood flow and arterial oxygenation.

show abstract

“…8, [122][123][124] Cold preservation causes the sinusoidal lining cells of the liver to become edematous and detach, leaving the hepatocyte microvilli exposed to the sinusoidal lumen and resulting in cell death. 124 The importance of monitoring donor sodium levels and correcting hypernatremia has been emphasized in several observational studies. Both ABO incompatibility and donor plasma sodium > 155 mmol·L -1 have been independently associated with an increased rate of recipient death and retransplantation.…”

Section: Hepatic Considerationsmentioning

confidence: 99%

Medical management to optimize donor organ potential: review of the literature

Kutsogiannis

Pagliarello

Doig

et al. 2006

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: Over the past two decades, the demand for donor organs continues to outpace the number of organs available for transplantation. Parallel with this has been a change in the demographics of organ donors with an increase in older donors and donors with marginal organs as a proportion of the total organ donor pool. Consequently, efforts have been made to improve the medical care delivered to potential organ donors to improve the conversion rate and graft survival of available organs. The purpose of this literature review is to provide updated recommendations for the contemporary management of organ donors after the neurological determination of death in order to maximize the probability of recipient graft survival. Sources:A comprehensive review of the literature obtained through searches of MEDLINE/PubMed, and personal reference files.Principal findings: Contemporary management of the organ donor after neurological determination of death includes therapies to prevent the detrimental effects of the autonomic storm, the use of invasive hemodynamic monitoring and aggressive respiratory therapy including therapeutic bronchoscopy in marginal heart and lung donors, and the use of hormonal therapy including vasopressin, corticosteroids, triiodothyronine or thyroxine, and insulin for the pituitary failure and inflammation seen in brain dead organ donors. The importance of normalizing donor physiology to optimize all available organs is stressed. Conclusion:Aggressive hemodynamic and respiratory management of solid organ donors, coupled with the use of hormonal therapy improves the rate of conversion and graft survival in solid organ recipients. Objectif

show abstract

Preservation and Reperfusion Injuries in Liver Allografts

Cited by 791 publications

References 0 publications

Cytochrome P-450 content and activity after cold storage of rat hepatocytes in university of wisconsin and sodium-lactobionate-sucrose solutions

Cytochrome P-450 content and activity after cold storage of rat hepatocytes in university of wisconsin and sodium-lactobionate-sucrose solutions

Changes in tissue oxygenation of the porcine liver measured by near-infrared spectroscopy

Medical management to optimize donor organ potential: review of the literature

Contact Info

Product

Resources

About