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. 2025 Nov 25:4:1662187.
doi: 10.3389/frtra.2025.1662187. eCollection 2025.

Glycocalyx kinetics and injury during liver procurement and transplantation as predictors of early graft dysfunction

Nassiba Beghdadi  1   2 , Alexis Texier  3 , Marc Antoine Allard  1   2 , Mylene Sebagh  2   4   5 , Nour Bousaleh  1 , Haitham Triki  1 , Daniel Pietrasz  1   2 , Nicolas Cabrit  1 , Nicolas Golse  1   2 , René Adam  1   2 , Cyrille Feray  1   2 , Peter J Lenting  3 , Stéphanie Roullet  1   3 , Daniel Azoulay  1   2
Affiliations

Glycocalyx kinetics and injury during liver procurement and transplantation as predictors of early graft dysfunction

Nassiba Beghdadi et al. Front Transplant. .

Abstract

Introduction: Ischemia-reperfusion injury causes endothelial damage, partly through degradation of the glycocalyx. This study aimed to evaluate glycocalyx degradation from graft procurement to reperfusion and assess its potential as a biomarker of early graft function (early allograft dysfunction, EAD).

Methods: This single-center observational prospective study was conducted at Paul Brousse Hospital from April 2022 to April 2023. All primary liver transplantation (LT) recipients were included. Glycocalyx degradation was assessed at procurement, at the end of cold ischemia, and during LT in liver graft caval effluent and correlated with liver histological injury. The primary endpoint was EAD, defined as a Model for Early Allograft Function score ≥9. We quantified glycocalyx components [Syndecan-1 (Synd-1), heparan sulfate, angiopoietin-1, and angiopoietin-2], inflammation (TNF-alpha), and cell death markers.

Results: Thirty-one patients were included; 12 (39%) developed EAD. Synd-1 plasma levels at procurement (donor Synd-1 level = d-Synd-1) were significantly higher in patients with EAD [12,173 pg/mL (10,538-17,570) vs. 6,282 pg/mL (4,604-10,002), p = 0.004]. A plasma d-Synd-1 cutoff of 9,419.7 pg/mL predicted EAD [AUC = 0.81, 95% confidence interval (95% CI) (0.65-0.97); sensitivity 83%; specificity 74%, positive predictive value = 67%, negative predictive value = 88%, p < 0.05]. d-Synd-1 ≥9,419.7 pg/mL was associated with severe post-LT complications (p = 0.007).

Conclusions: d-Synd-1 levels in graft effluent during procurement may serve as a predictor of early allograft dysfunction. Strategies aimed at protecting the endothelial during procurement could improve graft outcomes.

Keywords: angiopoietin (Ang); glycocalyx (MeSH: d019276); heparan sulfate (HS); ischemia–reperfusion (I/R) injury; liver transplantation complications; syndecan-1 (SDC1).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Kinetic evolution of glycocalyx alteration and cell injury during liver graft procurement and transplantation at three time points: (1) donor sampling time, (2) end of cold ischemia, and (3) reperfusion (results are expressed as median and IQR).
Figure 2
Figure 2
Kinetics of ischemia–reperfusion biomarkers at the time of liver graft procurement according to post-LT graft dysfunction (results expressed as median and IQR).
Figure 3
Figure 3
ROC curve identifying the optimal syndecan-1 threshold at the time of donor sampling for MEAF ≥9 (Youden’s test).
See this image and copyright information in PMC

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