Ischaemic preconditioning of the graft in adult living related right lobe liver transplantation: Impact on ischaemia-reperfusion injury and clinical relevance

Abstract

Background: Ischaemic preconditioning (IPC) of the right liver graft in the donor has not been studied in adult-to-adult living related liver transplantation (LRLT). Objective: To assess the IPC effect of the graft on ischaemia reperfusion injury in the recipient and compare recipient and donor outcomes with and without preconditioned grafts. Patients and methods: Alternate patients were transplanted with right lobe grafts that were (n = 22; Group Precond) or were not (n = 22; Group Control) subjected to IPC in the living donor. Liver ischaemia- reperfusion injury, liver/kidney function, morbidity/mortality rates and outcomes were compared. Univariate and multivariate analyses were performed to identify factors predictive of the aspartate aminotransferase (AST) peak and minimum prothrombin time. Results: Both groups had similar length of hospital stay, morbidity/mortality, primary non-function and acute rejection rates. Post-operative AST (P = 0.8) and alanine aminotransferase (ALT) peaks (P = 0.6) were similar in both groups (307 ± 189 and 437 ± 302 vs. 290 ± 146 and 496 ± 343, respectively). In univariate analysis, only pre-operative AST and warm ischemia time (WIT) were significantly associated with post-operative AST peak (in recipients). In multivariate analysis, the graft/recipient weight ratio (P = 0.003) and pre-operative bilirubin concentration (P = 0.004) were significantly predictive of minimum prothrombin time post-transplantation. Conclusions: Graft IPC in the living related donor is not associated with any benefit for the recipient or the donor and its clinical value remains uncertain. © 2010 International Hepato-Pancreato-Biliary Association.