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. 2021 Feb;21(2):614-625.
doi: 10.1111/ajt.16219. Epub 2020 Sep 10.

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

Takahiro Ito  1 , Bita V Naini  2 , Daniela Markovic  3 , Antony Aziz  1 , Stephanie Younan  1 , Michelle Lu  1 , Hirofumi Hirao  1 , Kentaro Kadono  1 , Hidenobu Kojima  1 , Joseph DiNorcia 3rd  1 , Vatche G Agopian  1 , Hasan Yersiz  1 , Douglas G Farmer  1 , Ronald W Busuttil  1 , Jerzy W Kupiec-Weglinski  1 , Fady M Kaldas  1
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Free article

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

Takahiro Ito et al. Am J Transplant. 2021 Feb.
Free article

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.

Keywords: early allograft dysfunction; graft survival; ischemia-reperfusion injury; liver biopsy; liver steatosis.

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References

REFERENCES

    1. Starzl TE, Marchioro TL, Vonkaulla KN, Hermann G, Brittain RS, Waddell WR. Homotransplantation of the liver in humans. Surg Gynecol Obstet. 1963;117:659-676.
    1. Agopian VG, Petrowsky H, Kaldas FM, et al. The evolution of liver transplantation during 3 decades: analysis of 5347 consecutive liver transplants at a single center. Ann Surg. 2013;258(3):409-421.
    1. Martin P, DiMartini A, Feng S, Brown R Jr, Fallon M. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology. 2014;59(3):1144-1165.
    1. EASL Clinical Practice Guidelines. Liver transplantation. J Hepatol. 2016;64(2):433-485.
    1. Fayek SA, Quintini C, Chavin KD, Marsh CL. The current state of liver transplantation in the United States: perspective from American Society of Transplant Surgeons (ASTS) Scientific Studies Committee and Endorsed by ASTS Council. Am J Transplant. 2016;16(11):3093-3104.

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