51
|
Adam R, Karam V, Cailliez V, O Grady JG, Mirza D, Cherqui D, Klempnauer J, Salizzoni M, Pratschke J, Jamieson N, Hidalgo E, Paul A, Andujar RL, Lerut J, Fisher L, Boudjema K, Fondevila C, Soubrane O, Bachellier P, Pinna AD, Berlakovich G, Bennet W, Pinzani M, Schemmer P, Zieniewicz K, Romero CJ, De Simone P, Ericzon BG, Schneeberger S, Wigmore SJ, Prous JF, Colledan M, Porte RJ, Yilmaz S, Azoulay D, Pirenne J, Line PD, Trunecka P, Navarro F, Lopez AV, De Carlis L, Pena SR, Kochs E, Duvoux C. 2018 Annual Report of the European Liver Transplant Registry (ELTR) - 50-year evolution of liver transplantation. Transpl Int 2019; 31:1293-1317. [PMID: 30259574 DOI: 10.1111/tri.13358] [Citation(s) in RCA: 289] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/19/2018] [Accepted: 09/22/2018] [Indexed: 02/07/2023]
Abstract
The purpose of this registry study was to provide an overview of trends and results of liver transplantation (LT) in Europe from 1968 to 2016. These data on LT were collected prospectively from 169 centers from 32 countries, in the European Liver Transplant Registry (ELTR) beginning in 1968. This overview provides epidemiological data, as well as information on evolution of techniques, and outcomes in LT in Europe over more than five decades; something that cannot be obtained from only a single center experience.
Collapse
Affiliation(s)
- René Adam
- Paul Brousse Hospital, Univ Paris-Sud, Inserm U935, Villejuif, France
| | - Vincent Karam
- Paul Brousse Hospital, Univ Paris-Sud, Inserm U935, Villejuif, France
| | - Valérie Cailliez
- Paul Brousse Hospital, Univ Paris-Sud, Inserm U935, Villejuif, France
| | | | | | - Daniel Cherqui
- Paul Brousse Hospital, Univ Paris-Sud, Inserm U935, Villejuif, France
| | | | | | | | | | | | | | | | - Jan Lerut
- Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Lutz Fisher
- Universitatsklinikum Hamburg Eppendorf, Hamburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Robert J Porte
- University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | | | - Pavel Trunecka
- Transplant Center, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | | | | | | | - Eberhard Kochs
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Munich, Germany
| | | | | |
Collapse
|
52
|
Mansard M, Siddachari R, Govil S, Doraiswamy S, Kumar G, Subramanian N, Arikichenin O. Is the Institute Georges Lopez-1 solution an equally effective, cheaper alternative to the University of Wisconsin solution in liver transplantation? INDIAN JOURNAL OF TRANSPLANTATION 2019. [DOI: 10.4103/ijot.ijot_61_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
53
|
Hameed AM, Pang T, Yoon P, Balderson G, De Roo R, Yuen L, Lam V, Laurence J, Crawford M, D M Allen R, Hawthorne WJ, Pleass HC. Aortic Versus Dual Perfusion for Retrieval of the Liver After Brain Death: A National Registry Analysis. Liver Transpl 2018; 24:1536-1544. [PMID: 30192420 DOI: 10.1002/lt.25331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 02/07/2023]
Abstract
There is lack of consensus in the literature regarding the comparative efficacy of in situ aortic-only compared with dual (aortic and portal venous) perfusion for retrieval and transplantation of the liver. Recipient outcomes from the Australia/New Zealand Liver Transplant Registry (2007-2016), including patient and graft survival and causes of graft loss, were stratified by perfusion route. Subgroup analyses were conducted for higher-risk donors. A total of 1382 liver transplantation recipients were analyzed (957 aortic-only; 425 dual perfusion). There were no significant differences in 5-year graft and patient survivals between the aortic-only and dual cohorts (80.1% versus 84.6% and 82.6% versus 87.8%, respectively) or in the odds ratios of primary nonfunction, thrombotic graft loss, or graft loss secondary to biliary complications or acute rejection. When analyzing only higher-risk donors (n = 369), multivariate graft survival was significantly less in the aortic-only cohort (hazard ratio, 0.49; 95% confidence interval, 0.26-0.92). Overall, there was a trend toward improved outcomes when dual perfusion was used, which became significant when considering higher-risk donors alone. Inferences into the ideal perfusion technique in multiorgan procurement will require further investigation by way of a randomized controlled trial, and outcomes after the transplantation of other organs will also need to be considered.
Collapse
Affiliation(s)
- Ahmer M Hameed
- Department of Surgery, Westmead Hospital, Sydney, Australia.,Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, Australia.,Sydney Medical School, University of Sydney
| | - Tony Pang
- Department of Surgery, Westmead Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney
| | - Peter Yoon
- Department of Surgery, Westmead Hospital, Sydney, Australia
| | - Glenda Balderson
- Australia and New Zealand Liver Transplant Registry, Princess Alexandra Hospital, Brisbane, Australia
| | - Ronald De Roo
- Department of Surgery, Westmead Hospital, Sydney, Australia
| | - Lawrence Yuen
- Department of Surgery, Westmead Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney
| | - Vincent Lam
- Department of Surgery, Westmead Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney
| | - Jerome Laurence
- Department of Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Michael Crawford
- Department of Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Richard D M Allen
- Department of Surgery, Westmead Hospital, Sydney, Australia.,Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, Australia.,Sydney Medical School, University of Sydney
| | - Wayne J Hawthorne
- Department of Surgery, Westmead Hospital, Sydney, Australia.,Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, Australia.,Sydney Medical School, University of Sydney
| | - Henry C Pleass
- Department of Surgery, Westmead Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney.,Department of Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| |
Collapse
|
54
|
The Effect of Histidine-tryptophan-ketoglutarate Solution and University of Wisconsin Solution: An Analysis of the Eurotransplant Registry. Transplantation 2018; 102:1870-1877. [DOI: 10.1097/tp.0000000000002406] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
55
|
Advancing Transplantation: New Questions, New Possibilities in Kidney and Liver Transplantation. Transplantation 2018; 101 Suppl 2S:S1-S41. [PMID: 28125449 DOI: 10.1097/tp.0000000000001563] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
56
|
Knecht C, Balaban CL, Rodríguez JV, Ceccarelli EA, Guibert EE, Rosano GL. Proteome variation of the rat liver after static cold storage assayed in an ex vivo model. Cryobiology 2018; 85:47-55. [PMID: 30296410 DOI: 10.1016/j.cryobiol.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/03/2018] [Accepted: 10/03/2018] [Indexed: 12/28/2022]
Abstract
Cold storage is a common procedure for liver preservation in a transplant setting. However, during cold ischemia, the liver suffers molecular alterations that can affect its performance. Also, deleterious mechanisms set forth in the storage phase are exacerbated during reperfusion. This study aimed to identify liver proteins associated with injury during cold storage and/or normothermic reperfusion using the isolated perfused rat liver model. Livers from male rats were subjected to either (1) cold storage for 24 h, (2) ex vivo normothermic reperfusion for 90 min or (3) cold storage for 24 h followed by ex vivo normothermic reperfusion for 90 min. Then, the livers were homogenized and proteins were extracted. Protein expression between each experimental group and the control (freshly resected livers) was compared by two-dimensional (2D) gel electrophoresis. Protein identification was carried out by matrix-assisted laser desorption/ionization time-of-flight spectrometry (MALDI-TOF/TOF) using MASCOT as the search engine. 23 proteins were detected with significantly altered levels of expression among the different treatments, including molecular chaperones, antioxidant enzymes, and proteins involved in energy metabolism. Some of them have been postulated as biomarkers for liver damage while others had been identified in other organs subjected to ischemia and reperfusion injury. The whole data set will be a useful resource for studying deleterious molecular mechanisms that result in diminished liver function during storage and subsequent reperfusion.
Collapse
Affiliation(s)
- Camila Knecht
- Instituto de Biología Molecular y Celular de Rosario (IBR), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, 2000, Argentina; Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada (CAIC), Universidad Nacional de Rosario, Rosario, 2000, Argentina.
| | - Cecilia L Balaban
- Instituto de Biología Molecular y Celular de Rosario (IBR), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, 2000, Argentina; Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada (CAIC), Universidad Nacional de Rosario, Rosario, 2000, Argentina.
| | - Joaquín V Rodríguez
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada (CAIC), Universidad Nacional de Rosario, Rosario, 2000, Argentina.
| | - Eduardo A Ceccarelli
- Instituto de Biología Molecular y Celular de Rosario (IBR), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, 2000, Argentina.
| | - Edgardo E Guibert
- Centro Binacional (Argentina-Italia) de Investigaciones en Criobiología Clínica y Aplicada (CAIC), Universidad Nacional de Rosario, Rosario, 2000, Argentina.
| | - Germán L Rosano
- Instituto de Biología Molecular y Celular de Rosario (IBR), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, 2000, Argentina.
| |
Collapse
|
57
|
Pfister ED, Karch A, Adam R, Polak WG, Karam V, Mirza D, O'Grady J, Klempnauer J, Reding R, Kalicinski P, Coker A, Trunecka P, Astarcioglu I, Jacquemin E, Pratschke J, Paul A, Popescu I, Schneeberger S, Boillot O, Fischer L, Mikolajczyk RT, Baumann U, Duvoux C. Predictive Factors for Survival in Children Receiving Liver Transplants for Wilson's Disease: A Cohort Study Using European Liver Transplant Registry Data. Liver Transpl 2018; 24:1186-1198. [PMID: 30021057 DOI: 10.1002/lt.25308] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/25/2018] [Indexed: 02/07/2023]
Abstract
Liver transplantation (LT) is a rescue therapy for life-threatening complications of Wilson's disease (WD). However, data on the outcome of WD patients after LT are scarce. The aim of our study was to analyze a large pediatric WD cohort with the aim of investigating the longterm outcome of pediatric WD patients after LT and to identify predictive factors for patient and transplant survival. This is a retrospective cohort study using data of all children (<18 years) transplanted for WD enrolled in the European Liver Transplant Registry from January 1968 until December 2013. In total, 338 patients (57.6% female) transplanted at 80 different European centers (1-26 patients per center) were included in this study. The median age at transplantation was 14.0 years (interquartile range [IQR], 11.2-16.1 years); patients were followed up for a median of 5.4 years (IQR, 1.0-10.9 years) after LT. Overall patient survival rates were high with 87% (1-year survival), 84% (5-year survival), and 81% (10-year survival); survival rates increased considerably with the calendar year (P < 0.001). Early age at LT, living donation, and histidine tryptophan ketoglutarate preservation liquid were identified as risk factors for poor patient survival in the multivariate analysis. LT is an excellent treatment option for pediatric patients with WD and associated end-stage liver disease. Longterm outcome in these patients is similar to other pediatric causes for LT. Overall patient and graft survival rates improved considerably over the last decades. To improve future research in the field, the vast variability of allocation strategies should be harmonized and a generally accepted definition or discrimination of acute versus chronic WD needs to be found.
Collapse
Affiliation(s)
- Eva-Doreen Pfister
- Division of Pediatric Gastroenterology and Hepatology, Departments of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover, Germany
| | - André Karch
- Research Group Epidemiological and Statistical Methods, Helmholtz Center for Infection Research, Braunschweig, Germany.,German Center for Infection Research, Hannover-Braunschweig, Germany
| | - René Adam
- European Liver Transplant Registry.,AP-HP Hôpital Paul Brousse, Université Paris-Sud, Center Hépato-Biliaire, INSERM U 935, Villejuif, France
| | | | - Vincent Karam
- European Liver Transplant Registry.,AP-HP Hôpital Paul Brousse, Université Paris-Sud, Center Hépato-Biliaire, INSERM U 935, Villejuif, France
| | - Darius Mirza
- Liver Unit, Elizabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - John O'Grady
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Jürgen Klempnauer
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | | | - Piotr Kalicinski
- Department of Pediatric and Transplant Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Ahmet Coker
- Department of Gastroenterology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Pavel Trunecka
- Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ibrahim Astarcioglu
- HPB Surgery and Liver Transplantation Unit, Department of General Surgery, School of Medicine, Dokuz Eylul University, Inciralti, İzmir, Turkey
| | - Emmanual Jacquemin
- AP-HP Hôpital Paul Brousse, Université Paris-Sud, Center Hépato-Biliaire, INSERM U 935, Villejuif, France
| | | | - Andreas Paul
- Department of General and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - Irinel Popescu
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Oliver Boillot
- Liver Transplant Unit, Edouard Herriot Hospital, Lyon, France
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rafael T Mikolajczyk
- Research Group Epidemiological and Statistical Methods, Helmholtz Center for Infection Research, Braunschweig, Germany.,German Center for Infection Research, Hannover-Braunschweig, Germany
| | - Ulrich Baumann
- Division of Pediatric Gastroenterology and Hepatology, Departments of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover, Germany
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, AP-HP Henri Mondor Hospital, Paris Est University, Créteil, France
| | | |
Collapse
|
58
|
Panisello-Roselló A, Alva N, Flores M, Lopez A, Castro Benítez C, Folch-Puy E, Rolo A, Palmeira C, Adam R, Carbonell T, Roselló-Catafau J. Aldehyde Dehydrogenase 2 (ALDH2) in Rat Fatty Liver Cold Ischemia Injury. Int J Mol Sci 2018; 19:2479. [PMID: 30131474 PMCID: PMC6164398 DOI: 10.3390/ijms19092479] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/14/2018] [Accepted: 08/18/2018] [Indexed: 12/31/2022] Open
Abstract
Institut George Lopez-1 (IGL-1) and Histidine-tryptophan-ketoglutarate (HTK) solutions are proposed as alternatives to UW (gold standard) in liver preservation. Their composition differs in terms of the presence/absence of oncotic agents such as HES or PEG, and is decisive for graft conservation before transplantation. This is especially so when fatty (steatotic) livers are used since these grafts are more vulnerable to ischemia insult during conservation. Their composition determines the extent of the subsequent reperfusion injury after transplantation. Aldehyde dehydrogenase-2 (ALDH2), a mitochondrial enzyme, has been reported to play a protective role in warm ischemia-reperfusion injury (IRI), but its potential in fatty liver cold ischemic injury has not yet been investigated. We evaluated the relevance of ALDH2 activity in cold ischemia injury when fatty liver grafts from Zucker Obese rats were preserved in UW, HTK, and IGL-1 solutions, in order to study the mechanisms involved. ALDH2 upregulation was highest in livers preserved in IGL-1. It was accompanied by a decrease in transaminases, apoptosis (Caspase 3 and TUNEL assay), and lipoperoxidation, which was concomitant with the effective clearance of toxic aldehydes such as 4-hydroxy-nonenal. Variations in ATP levels were also determined. The results were consistent with levels of NF-E2 p45-related factor 2 (Nrf2), an antioxidant factor. Here we report for the first time the relevance of mitochondrial ALDH2 in fatty liver cold preservation and suggest that ALDH2 could be considered a potential therapeutic target or regulator in clinical transplantation.
Collapse
Affiliation(s)
- Arnau Panisello-Roselló
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC), 08036 Barcelona, Catalonia, Spain.
| | - Norma Alva
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Catalonia, Spain.
| | - Marta Flores
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Catalonia, Spain.
| | - Alexandre Lopez
- Centre Hépato-Biliaire, AP-PH, Hôpital Paul Brousse, 94800 Paris, France.
| | | | - Emma Folch-Puy
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC), 08036 Barcelona, Catalonia, Spain.
| | - Anabela Rolo
- Center for Neurosscience and Cell Biology, Universidade de Coimbra, 300-370 Coimbra, Portugal.
| | - Carlos Palmeira
- Center for Neurosscience and Cell Biology, Universidade de Coimbra, 300-370 Coimbra, Portugal.
| | - René Adam
- Centre Hépato-Biliaire, AP-PH, Hôpital Paul Brousse, 94800 Paris, France.
| | - Teresa Carbonell
- Department of Cell Biology, Physiology and Immunology, Faculty of Biology, Universitat de Barcelona, 08028 Barcelona, Catalonia, Spain.
| | - Joan Roselló-Catafau
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC), 08036 Barcelona, Catalonia, Spain.
| |
Collapse
|
59
|
Alva N, Panisello-Roselló A, Flores M, Roselló-Catafau J, Carbonell T. Ubiquitin-proteasome system and oxidative stress in liver transplantation. World J Gastroenterol 2018; 24:3521-3530. [PMID: 30131658 PMCID: PMC6102496 DOI: 10.3748/wjg.v24.i31.3521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/28/2018] [Accepted: 06/30/2018] [Indexed: 02/06/2023] Open
Abstract
A major issue in organ transplantation is the development of a protocol that can preserve organs under optimal conditions. Damage to organs is commonly a consequence of flow deprivation and oxygen starvation following the restoration of blood flow and reoxygenation. This is known as ischemia-reperfusion injury (IRI): a complex multifactorial process that causes cell damage. While the oxygen deprivation due to ischemia depletes cell energy, subsequent tissue oxygenation due to reperfusion induces many cascades, from reactive oxygen species production to apoptosis initiation. Autophagy has also been identified in the pathogenesis of IRI, although such alterations and their subsequent functional significance are controversial. Moreover, proteasome activation may be a relevant pathophysiological mechanism. Different strategies have been adopted to limit IRI damage, including the supplementation of commercial preservation media with pharmacological agents or additives. In this review, we focus on novel strategies related to the ubiquitin proteasome system and oxidative stress inhibition, which have been used to minimize damage in liver transplantation.
Collapse
Affiliation(s)
- Norma Alva
- Department of Cell Biology, Physiology and Immunology, University of Barcelona, Barcelona 08028, Spain
| | - Arnau Panisello-Roselló
- Experimental Pathology Department, Institute of Biomedical Research of Barcelona, Barcelona 08036, Spain
| | - Marta Flores
- Department of Cell Biology, Physiology and Immunology, University of Barcelona, Barcelona 08028, Spain
| | - Joan Roselló-Catafau
- Experimental Pathology Department, Institute of Biomedical Research of Barcelona, Barcelona 08036, Spain
| | - Teresa Carbonell
- Department of Cell Biology, Physiology and Immunology, University of Barcelona, Barcelona 08028, Spain
| |
Collapse
|
60
|
Panisello-Rosello A, Castro-Benítez C, Lopez A, Balloji S, Folch-Puy E, Adam R, Roselló-Catafau J. Graft Protection Against Cold Ischemia Preservation: An Institute George Lopez 1 and Histidine-tryptophan-ketoglutarate Solution Appraisal. Transplant Proc 2018; 50:714-718. [PMID: 29661422 DOI: 10.1016/j.transproceed.2018.02.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cold storage of organs in preservation solutions, such as Institute George Lopez 1 (IGL-1) or histidine-tryptophan-ketoglutarate (HTK), is a mandatory step for organ transplantation. This preservation leads to an ischemic injury that affects the outcome of the organ. This article studies the liver graft eluate after organ recovery using IGL-1 or HTK solutions. We explore the influence of the volume used for washing out the liver and the consequences in the graft preservation when both solutions are used. Livers were washed out with different volumes of HTK and IGL-1 according to manufacturers' instructions and then preserved in both solutions for 24 hours at 4°C. Tissue and eluates were collected for subsequent analyses. We measured transaminases (aspartate aminotransferase and alanine aminotransferase), histology by hematoxylin/eosin staining, and red blood cell and hemoglobin counts, respectively. After washing out and cold storage, the IGL-1 processed livers showed better preservation than those with HTK solution; however, in this latter case, an important accumulation of erythrocytes was found when compared to IGL-1. These data were consistent with the higher hemoglobin and red blood cell counts observed for IGL-1 eluates after 24 hours. The volume used for washing out the organ depends on the composition and properties of the organ preservation solutions (ie, IGL-1 and HTK); this is an important factor for the graft cold preservation. The total volume used for washing out the graft should be considered because it has a direct impact on the total cost for clinical transplantations.
Collapse
Affiliation(s)
- A Panisello-Rosello
- Institut d'Investigacions Biomèdiques de Barcelona (IIBB), CSIC-IDIBAPS, Catalonia, Barcelona, Spain
| | - C Castro-Benítez
- Centre Hepato-Biliare, AP-P-HP Hôpital Paul Brousse, Inserm U776, Univesité Paris-Sud, Villejuif, Paris, France
| | - A Lopez
- Centre Hepato-Biliare, AP-P-HP Hôpital Paul Brousse, Inserm U776, Univesité Paris-Sud, Villejuif, Paris, France
| | - S Balloji
- Institut d'Investigacions Biomèdiques de Barcelona (IIBB), CSIC-IDIBAPS, Catalonia, Barcelona, Spain
| | - E Folch-Puy
- Institut d'Investigacions Biomèdiques de Barcelona (IIBB), CSIC-IDIBAPS, Catalonia, Barcelona, Spain
| | - R Adam
- Centre Hepato-Biliare, AP-P-HP Hôpital Paul Brousse, Inserm U776, Univesité Paris-Sud, Villejuif, Paris, France
| | - J Roselló-Catafau
- Institut d'Investigacions Biomèdiques de Barcelona (IIBB), CSIC-IDIBAPS, Catalonia, Barcelona, Spain.
| |
Collapse
|
61
|
León Díaz FJ, Fernández Aguilar JL, Nicolás de Cabo S, Pérez Reyes M, Sánchez Pérez B, Montiel Casado C, Pérez Daga JA, Aranda Narváez JM, Suárez Muñoz MA, Arenas González F, Florez Rías MM, Pelaez Angulo JL, Santoyo Santoyo J. Combined Flush With Histidine-Tryptophan-Ketoglutarate and University of Wisconsin Solutions in Liver Transplantation: Preliminary Results. Transplant Proc 2018; 50:539-542. [PMID: 29579846 DOI: 10.1016/j.transproceed.2017.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 11/20/2017] [Accepted: 12/05/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Ischemia reperfusion injury (IRI) is the main cause of early allograft dysfunction (EAD) and subsequent primary allograft failure (PAF). OBJECTIVES The purpose of this study is to compare IRI, EAD, and PAF in liver transplantation in a cohort of patients perfused with histidine-tryptophan-ketoglutarate (HTK) solution and University of Wisconsin (UW) solution versus HTK alone. METHODS A randomized trial was performed to compare outcomes in liver recipients who underwent transplantation surgery in the University Regional Hospital of Malaga, Spain. Forty patients were randomized to two groups. Primary endpoints included IRI, EAD, PAF, re-intervention, acute cellular rejection, retransplantation, arterial complications, and biliary complications at postoperative day 90. RESULTS Postoperative glutamic oxaloacetic transaminase (1869.15 ± 1559.75 UI/L vs. 953.15 ± 777.27 UI/L; P = .004) and glutamic pyruvic transaminase (1333.60 ± 1115.49 U/L vs. 721.70 ± 725.02 U/L; P = .023) were significantly higher in patients perfused with HTK alone. A clear tendency was observed in recipients perfused with HTK alone to present moderate to severe IRI (7 patients in the HTK + UW solution group vs. 15 patients in the HTK-alone solution group; P = .06), EAD (0 patients in the HTK + UW solution group vs. 0 patients in the HTK-alone solution group; P = .76), and PAF (3 patients in the HTK + UW solution group vs. 8 patients in the HTK-alone solution group; P = .15). CONCLUSIONS Initial perfusion with HTK solution followed by UW solution in liver transplantation improves early liver function as compared to perfusion with HTK alone.
Collapse
Affiliation(s)
- F J León Díaz
- Faculty of Medicine, University of Malaga, Malaga, Spain; Department of Surgery, Liver Transplant Unit, Regional Hospital, Málaga, Spain.
| | - J L Fernández Aguilar
- Faculty of Medicine, University of Malaga, Malaga, Spain; Department of Surgery, Liver Transplant Unit, Regional Hospital, Málaga, Spain
| | - S Nicolás de Cabo
- Department of Surgery, Liver Transplant Unit, Regional Hospital, Málaga, Spain
| | - M Pérez Reyes
- Department of Surgery, Liver Transplant Unit, Regional Hospital, Málaga, Spain
| | - B Sánchez Pérez
- Department of Surgery, Liver Transplant Unit, Regional Hospital, Málaga, Spain
| | - C Montiel Casado
- Department of Surgery, Liver Transplant Unit, Regional Hospital, Málaga, Spain
| | - J A Pérez Daga
- Department of Surgery, Liver Transplant Unit, Regional Hospital, Málaga, Spain
| | - J M Aranda Narváez
- Department of Surgery, Liver Transplant Unit, Regional Hospital, Málaga, Spain
| | - M A Suárez Muñoz
- Department of Surgery, Liver Transplant Unit, Regional Hospital, Málaga, Spain
| | - F Arenas González
- Department of Surgery, Liver Transplant Unit, Regional Hospital, Málaga, Spain
| | - M M Florez Rías
- Department of Pathologic Anatomy, Regional Hospital, Málaga, Spain
| | | | - J Santoyo Santoyo
- Faculty of Medicine, University of Malaga, Malaga, Spain; Department of Surgery, Liver Transplant Unit, Regional Hospital, Málaga, Spain
| |
Collapse
|
62
|
Lopez A, Panisello-Rosello A, Castro-Benitez C, Adam R. Glycocalyx Preservation and NO Production in Fatty Livers-The Protective Role of High Molecular Polyethylene Glycol in Cold Ischemia Injury. Int J Mol Sci 2018; 19:ijms19082375. [PMID: 30103565 PMCID: PMC6121886 DOI: 10.3390/ijms19082375] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/10/2018] [Accepted: 08/11/2018] [Indexed: 01/23/2023] Open
Abstract
Improving the protection of marginal liver grafts during static cold storage is a major hurdle to increase the donor pool of organs. The endothelium glycocalyx quality of preservation influences future inflammatory and oxidative responses. One cellular pathway responsible for the formation of nitric oxide by endothelial cells is dependent on the stimulation of proteoglycans present in the glycocalyx. We investigated the impact of the glycocalyx preservation in static cold storage of fatty liver preserved in different preservation solutions on the endothelium-mediated production of NO. Zucker fatty rat livers were preserved 24 h in static cold storage in either Institut Georges Lopez-1 (IGL-1) (n = 10), IGL-0 (i.e., without PEG35) (n = 5) or Histidine-Tryptophan-Ketoglutarate (HTK) (n = 10) preservation solutions before being processed for analysis. For Sham group (n = 5), the fatty livers were immediately analyzed after procurement. The level of transaminases and nitrites/nitrates were measured in the washing perfusate. Glycocalyx proteins expressions, Syndecan-1, glypican-1 and heparan sulfate (HS), were determined in the tissue (ELISA). Steatotic livers preserved 24 h in IGL-1 preservation solution have a significant lower level of transaminases (aspartate aminotransferase (AST), alanine aminotransferase (ALT)) and less histological damages than steatotic livers preserved 24 h with HTK (p = 0.0152). The syndecan-1 is significantly better preserved in IGL-1 group compared to HTK (p < 0.0001) and we observed the same tendency compared to IGL-0. No significant differences were observed with glypican-1. HS expression in HTK group was significantly higher compared to the three other groups. HS level in IGL-1 was even lower than IGL-0 (p = 0.0005) which was similar to Sham group. The better protection of the glycocalyx proteins in IGL-1 group was correlated with a higher production of NO than HTK (p = 0.0055) or IGL-0 (p = 0.0433). IGL-1 protective mechanisms through the formation of NO could be due to its better protective effects on the glycocalyx during SCS compared to other preservation solutions. This beneficial effect could involve the preservation state of syndecan-1 and the internalization of HS.
Collapse
Affiliation(s)
- Alexandre Lopez
- INSERM U935, Université Paris-sud, Villejuif, 94800 Paris, France.
| | | | - Carlos Castro-Benitez
- INSERM U935, Université Paris-sud, Villejuif, 94800 Paris, France.
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Villejuif, 94800 Paris, France.
| | - René Adam
- INSERM U935, Université Paris-sud, Villejuif, 94800 Paris, France.
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Villejuif, 94800 Paris, France.
| |
Collapse
|
63
|
Rock N, Ansari M, Villard J, Ferrari-Lacraz S, Waldvogel S, McLin VA. Factors associated with immune hemolytic anemia after pediatric liver transplantation. Pediatr Transplant 2018; 22:e13230. [PMID: 29885007 DOI: 10.1111/petr.13230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2018] [Indexed: 01/27/2023]
Abstract
Immune-mediated hemolytic anemia following SOT is a rare disorder, the risk factors for which are unknown. Our purpose was to analyze a seemingly increased incidence in our center with the aim to identify predisposing factors. This recipients single-center retrospective study reviewed the medical records of 96 pediatric LT between 2000 and 2013. IHA was defined as acute anemia with a positive direct antiglobulin test. Seven cases of immune-mediated hemolytic anemia were identified (incidence 8.5%). Three cases presented during the first 3 months following LT (early IHA), and 4 presented later (late IHA). All patients with late IHA required rituximab. Using univariate analysis, the following factors were associated with IHA onset: BA (P = .04), younger age (P = .04), and the use of IGL-1 preservation solution (P = .05). Late IHA was associated with viral infections occurring beyond 3 months following LT, younger age, and BA (P = .01). Overall, CMV infection was associated with the development of both early and late IHA: CMV-negative recipients who received an organ from a CMV-positive donor were more likely to develop IHA (P = .035), and de novo CMV infection during the first year post-LT was associated with late IHA (P = .03). IHA is a rare complication following pediatric LT, occurring more frequently in younger patients and patients with an initial diagnosis of BA. CMV-negative recipients and patients who experience a de novo CMV infection in the first year following LT seem particularly vulnerable. IGL-1 preservation solution may be associated with an increased likelihood of developing IHA, a novel finding which warrants further investigation.
Collapse
Affiliation(s)
- Nathalie Rock
- Swiss Center for Liver Disease in Children, University Hospitals Geneva, Geneva, Switzerland
| | - Marc Ansari
- Pediatric Hematology and Oncology Unit, University Hospitals Geneva, Geneva, Switzerland
| | - Jean Villard
- Transplant Immunology Unit, Division of Immunology and Allergy, University Hospitals Geneva, Geneva, Switzerland
| | - Sylvie Ferrari-Lacraz
- Transplant Immunology Unit, Division of Immunology and Allergy, University Hospitals Geneva, Geneva, Switzerland
| | - Sophie Waldvogel
- Immunology and Hematology Laboratory, University Hospitals Geneva, Geneva, Switzerland
| | - Valérie Anne McLin
- Swiss Center for Liver Disease in Children, University Hospitals Geneva, Geneva, Switzerland
| |
Collapse
|
64
|
Hameed AM, Laurence JM, Lam VWT, Pleass HC, Hawthorne WJ. Reply. Liver Transpl 2018; 24:1144-1146. [PMID: 29742806 DOI: 10.1002/lt.25195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/22/2016] [Accepted: 10/31/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Ahmer M Hameed
- Center for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.,Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Jerome M Laurence
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.,Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Vincent W T Lam
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Henry C Pleass
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.,Department of Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Wayne J Hawthorne
- Center for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.,Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
65
|
Adam R, Cailliez V, Segev DL, Karam V. A Systematic Review and Meta-Analysis of Cold In Situ Perfusion and Preservation of the Hepatic Allograft: Working Toward a Unified Approach. Liver Transpl 2018; 24:1142-1143. [PMID: 29923365 DOI: 10.1002/lt.25208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/22/2018] [Accepted: 05/20/2018] [Indexed: 12/15/2022]
Affiliation(s)
- René Adam
- Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris-Sud, INSERM U 935, Villejuif, France
| | - Valérie Cailliez
- Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris-Sud, INSERM U 935, Villejuif, France
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vincent Karam
- Hôpital Paul Brousse, Centre Hépato-Biliaire, Université Paris-Sud, INSERM U 935, Villejuif, France
| |
Collapse
|
66
|
Panisello-Roselló A, Lopez A, Folch-Puy E, Carbonell T, Rolo A, Palmeira C, Adam R, Net M, Roselló-Catafau J. Role of aldehyde dehydrogenase 2 in ischemia reperfusion injury: An update. World J Gastroenterol 2018; 24:2984-2994. [PMID: 30038465 PMCID: PMC6054945 DOI: 10.3748/wjg.v24.i27.2984] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/28/2018] [Accepted: 06/30/2018] [Indexed: 02/06/2023] Open
Abstract
Aldehyde dehydrogenase 2 (ALDH2) is best known for its critical detoxifying role in liver alcohol metabolism. However, ALDH2 dysfunction is also involved in a wide range of human pathophysiological situations and is associated with complications such as cardiovascular diseases, diabetes mellitus, neurodegenerative diseases and aging. A growing body of research has shown that ALDH2 provides important protection against oxidative stress and the subsequent loading of toxic aldehydes such as 4-hydroxy-2-nonenal and adducts that occur in human diseases, including ischemia reperfusion injury (IRI). There is increasing evidence of its role in IRI pathophysiology in organs such as heart, brain, small intestine and kidney; however, surprisingly few studies have been carried out in the liver, where ALDH2 is found in abundance. This study reviews the role of ALDH2 in modulating the pathways involved in the pathophysiology of IRI associated with oxidative stress, autophagy and apoptosis. Special emphasis is placed on the role of ALDH2 in different organs, on therapeutic “preconditioning” strategies, and on the use of ALDH2 agonists such as Alda-1, which may become a useful therapeutic tool for preventing the deleterious effects of IRI in organ transplantation.
Collapse
Affiliation(s)
- Arnau Panisello-Roselló
- Department of Experimental Pathology, Institute of Biomedical Research of Barcelona (IIBB)-CSIC, Barcelona 08036, Spain
| | - Alexandre Lopez
- Centre Hepatobiliare, AP-HP Hôpital Paul Brousse, Villejuif 75008, France
| | - Emma Folch-Puy
- Department of Experimental Pathology, Institute of Biomedical Research of Barcelona (IIBB)-CSIC, Barcelona 08036, Spain
| | - Teresa Carbonell
- Department of Physiology, Faculty of Biology, Universitat de Barcelona, Barcelona 08036, Spain
| | - Anabela Rolo
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra 3004-517, Portugal
| | - Carlos Palmeira
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra 3004-517, Portugal
| | - René Adam
- Centre Hepatobiliare, AP-HP Hôpital Paul Brousse, Villejuif 75008, France
| | - Marc Net
- Institute Georges Lopez, Lissieu 69380, France
| | - Joan Roselló-Catafau
- Department of Experimental Pathology, Institute of Biomedical Research of Barcelona (IIBB)-CSIC, Barcelona 08036, Spain
| |
Collapse
|
67
|
Mangus RS, Schroering JR, Hathaway TJ, Kubal CA, Fridell JA. Comparison of Histidine-Tryptophan-Ketoglutarate and University of Wisconsin preservation solutions in pediatric liver transplantation. Pediatr Transplant 2018; 22:e13252. [PMID: 29907993 DOI: 10.1111/petr.13252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2018] [Indexed: 11/28/2022]
Abstract
UW and HTK solutions are the two primary organ preservation solutions most used in the United States. This study analyzes use of the two solutions in all pediatric liver transplants performed at a single center between 2001and 2017. Outcome measures included early graft function, as well as graft and patient survival. Bile duct complications were reviewed. Operative technique, immunosuppressive protocols, and donor acceptance criteria remained uniform among participating surgeons throughout the study period. There were 104 pediatric liver transplants with complete data during the study period, 75 preserved with HTK (68%) and 29 with UW (26%). Demographics were similar. Cold and warm ischemia times were similar. Peak ALT post-transplant was higher in the UW group at both peak and post-transplant day 3. The peak TB levels were similar. Bile duct strictures were more common in the UW group (44% vs 16%, P < .01). Early graft survival was statistically similar at 7-, 90- and 365-days post-transplant. Cox regression graft survival was similar at 10-years. This study suggests that use of HTK in pediatric liver transplantation is safe with outcomes similar to UW, though bile duct stricture rates may be lower with HTK.
Collapse
Affiliation(s)
- Richard S Mangus
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joel R Schroering
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Taylor J Hathaway
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chandrashekhar A Kubal
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jonathan A Fridell
- Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
68
|
Szilágyi ÁL, Mátrai P, Hegyi P, Tuboly E, Pécz D, Garami A, Solymár M, Pétervári E, Balaskó M, Veres G, Czopf L, Wobbe B, Szabó D, Wagner J, Hartmann P. Compared efficacy of preservation solutions on the outcome of liver transplantation: Meta-analysis. World J Gastroenterol 2018; 24:1812-1824. [PMID: 29713134 PMCID: PMC5922999 DOI: 10.3748/wjg.v24.i16.1812] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/02/2018] [Accepted: 04/09/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the effects of the four most commonly used preservation solutions on the outcome of liver transplantations. METHODS A systematic literature search was performed using MEDLINE, Scopus, EMBASE and the Cochrane Library databases up to January 31st, 2017. The inclusion criteria were comparative, randomized controlled trials (RCTs) for deceased donor liver (DDL) allografts with adult and pediatric donors using the gold standard University of Wisconsin (UW) solution or histidine-tryptophan-ketoglutarate (HTK), Celsior (CS) and Institut Georges Lopez (IGL-1) solutions. Fifteen RCTs (1830 livers) were included; the primary outcomes were primary non-function (PNF) and one-year post-transplant graft survival (OGS-1). RESULTS All trials were homogenous with respect to donor and recipient characteristics. There was no statistical difference in the incidence of PNF with the use of UW, HTK, CS and IGL-1 (RR = 0.02, 95%CI: 0.01-0.03, P = 0.356). Comparing OGS-1 also failed to reveal any difference between UW, HTK, CS and IGL-1 (RR = 0.80, 95%CI: 0.80-0.80, P = 0.369). Two trials demonstrated higher PNF levels for UW in comparison with the HTK group, and individual studies described higher rates of biliary complications where HTK and CS were used compared to the UW and IGL-1 solutions. However, the meta-analysis of the data did not prove a statistically significant difference: the UW, CS, HTK and IGL-1 solutions were associated with nearly equivalent outcomes. CONCLUSION Alternative solutions for UW yield the same degree of safety and effectiveness for the preservation of DDLs, but further well-designed clinical trials are warranted.
Collapse
Affiliation(s)
| | - Péter Mátrai
- Institute of Bioanalysis, University of Pécs, Pécs H-7624, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine and First Department of Medicine, University of Pécs, Pécs H-7624, Hungary
- MTA-SZTE Translational Gastroenterology Research Group, Szeged H-6720, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs H-7624, Hungary
| | - Eszter Tuboly
- Institute of Surgical Research, University of Szeged, Szeged H-6720, Hungary
| | - Daniella Pécz
- Institute of Surgical Research, University of Szeged, Szeged H-6720, Hungary
| | - András Garami
- Institute for Translational Medicine and First Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Margit Solymár
- Institute for Translational Medicine and First Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Erika Pétervári
- Institute for Translational Medicine and First Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Márta Balaskó
- Institute for Translational Medicine and First Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Gábor Veres
- 1st Department of Paediatrics, University of Semmelweis, Budapest H-1085, Hungary
| | - László Czopf
- Department of Cardiology, 1st Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Bastian Wobbe
- Department of Cardiology, 1st Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Dorottya Szabó
- Department of Cardiology, 1st Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Juliane Wagner
- Department of Cardiology, 1st Department of Medicine, University of Pécs, Pécs H-7624, Hungary
| | - Petra Hartmann
- Institute of Surgical Research, University of Szeged, Szeged H-6720, Hungary
| |
Collapse
|
69
|
Rao F, Yang J, Gong C, Huang R, Wang Q, Shen J. Systematic review of preservation solutions for allografts for liver transplantation based on a network meta-analysis. Int J Surg 2018; 54:1-6. [PMID: 29684666 DOI: 10.1016/j.ijsu.2018.04.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/09/2018] [Accepted: 04/12/2018] [Indexed: 01/20/2023]
Abstract
AIMS The aim of this work was to determine the best preservation solutions for allografts for liver transplantation by quantitative network meta-analysis. METHODS Global electronic databases including PubMed, EMBASE, and Cochrane Library were searched for relevant randomized controlled trials. Seven pieces of parametric data were extracted from included studies for pooled estimation. A consistency model was used for direct and indirect comparisons. The cumulative probability P value was utilized to rank the solutions. A node-splitting model was utilized for testing the consistency of final data. Quality of evidence was assessed using the GRADE (Grades of Recommendations Assessment, Development and Evaluation) system. RESULTS Eleven 2-arm trials including 1319 patients and 5 different solutions were finally included. HTK (Histidine-tryptophan-ketoglutarate) solution exhibited the best efficacy for decreasing the primary dysfunction rate, biliary complications and ICU-stay time (probability P = 0.43, 0.45 and 0.58, respectively). Celsior solution significantly decreased the rate of rejection and early retransplantation (probability P = 0.73 and 0.38, respectively), and enhanced patient and graft survival (probability P = 0.90 and 0.98, respectively) more than did other solutions. Overall, the quality of evidence was rated high or moderate. CONCLUSIONS We suggested that HTK solution may offer the best safety during the perioperative period. However, Celsior solution led to better graft tolerance and exhibited greater benefit for long-term outcomes. And our conclusions still need to be further validated.
Collapse
Affiliation(s)
- Fengying Rao
- School of Nursing, Huanggang Polytechnic College, Huanggang, 438002, PR China
| | - Jian Yang
- School of Nursing, Huanggang Polytechnic College, Huanggang, 438002, PR China
| | - Cheng Gong
- Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, PR China
| | - Rong Huang
- School of Nursing, Huanggang Polytechnic College, Huanggang, 438002, PR China
| | - Qi Wang
- The 1st Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, PR China.
| | - Jun Shen
- Emergency Center, Zhongnan Hospital of Wuhan University, 430071, Hubei Province, PR China.
| |
Collapse
|
70
|
Wiederkehr JC, Igreja MR, Gonçalves N, Nogara M, Godoy M, Drago C, Massutti AM, Wiederkehr HA, Wiederkehr BA. Liver Transplantation Using Prolonged Cold Ischemia Time Grafts Preserved With Institute George-Lopez-1 Solution. Transplant Proc 2018; 50:711-713. [PMID: 29661421 DOI: 10.1016/j.transproceed.2018.02.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Institute George-Lopez-1 (IGL-1) solution is a preservation solution with lower potassium and lower viscosity than the University of Wisconsin solution that has been recently used in liver transplantation. In the present series, we compare the outcome of liver grafts from brain-dead donors preserved in IGL-1cold storage solution, with cold ischemia times (CITs) longer than 8 hours and those less than 8 hours. Two hundred fifty-two liver transplantations performed from January 2014 to December 2016 at Hospital Santa Isabel, Blumenau, Brazil, were retrospectively analyzed. The patients were divided in two groups according to the CIT. Group I patients (N = 155) had less than 8 hours of CIT with a mean age of 54 ± 11.35 years, whereas group II patients (N = 97) had more than 8 hours of CIT with a mean age of 52 ± 12.5 years. There was no difference between the groups related to indication for liver transplantation and donor characteristics. The only difference statically significant on laboratory data was between the levels of aspartate aminotransferase at day 1 after transplantation. On day 7 post-transplantation there was no difference statistically significant between aspartate aminotransferase, alanine aminotransferase, and bilirubin levels between the two groups. Similar 1-year patient survival rates were found in both groups, with 85.88% for group I and 85.75% in group II. The IGL-1 solution has been shown to be safe, effective, and with good results in liver transplantations. Early graft function and 1-year patient survival rates did not differ when grafts preserved for less than 8 hours were compared to those with CIT greater than 8 hours.
Collapse
Affiliation(s)
- J C Wiederkehr
- Liver Transplant Division, Santa Isabel Hospital, Blumenau, SC, Brazil.
| | - M R Igreja
- Liver Transplant Division, Santa Isabel Hospital, Blumenau, SC, Brazil
| | - N Gonçalves
- Liver Transplant Division, Santa Isabel Hospital, Blumenau, SC, Brazil
| | - M Nogara
- Liver Transplant Division, Santa Isabel Hospital, Blumenau, SC, Brazil
| | - M Godoy
- Liver Transplant Division, Santa Isabel Hospital, Blumenau, SC, Brazil
| | - C Drago
- Liver Transplant Division, Santa Isabel Hospital, Blumenau, SC, Brazil
| | - A M Massutti
- Liver Transplant Division, Santa Isabel Hospital, Blumenau, SC, Brazil
| | - H A Wiederkehr
- Liver Transplant Division, Santa Isabel Hospital, Blumenau, SC, Brazil
| | - B A Wiederkehr
- Liver Transplant Division, Santa Isabel Hospital, Blumenau, SC, Brazil
| |
Collapse
|
71
|
Tabka D, Bejaoui M, Javellaud J, Achard JM, Ben Abdennebi H. Angiotensin IV improves subnormothermic machine perfusion preservation of rat liver graft. Biomed Pharmacother 2018; 104:841-847. [PMID: 29609847 DOI: 10.1016/j.biopha.2018.02.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/31/2018] [Accepted: 02/19/2018] [Indexed: 12/25/2022] Open
Abstract
This study aims to determine whether Angiotensin IV (Ang IV) addition to Celsior preservation solution could improve hepatic endothelium function and provide better liver protection during subnormothermic machine preservation (SMP). Two experimental models were used: In the first part of the study, rings isolated from rat hepatic artery were preserved in Celsior solution (6 h, 20 °C) with and without Ang IV (10-9 M), then, endothelium-dependent relaxation (EDR) and the concentration of acetylcholine inducing half-maximal relaxation of pre-contracted rings (EC50) were measured. Also, in order to investigate the implication of nitric oxide (NO) on EDR, the rings of hepatic artery were incubated with L-NG-nitroarginine metyl ester (L-NAME). In the second part of the study, rat livers were subjected to SMP with oxygenated Celsior solution (6 h, 20 °C), supplemented or not with Ang IV (10-9 M) and then perfused (2 h, 37 °C) with Krebs Henseleit solution. We found that Ang IV supplementation to Celsior solution decreased EC50 value and improved EDR of hepatic artery rings, 6h after sub-normothermic preservation. Interestingly, Ang IV amplified the vessel relaxation in a NO-dependent manner. Moreover, liver SMP with Ang IV reduced oxidative stress and cell injury and improved organ function. Ang IV activated pAkt, increased eNOS protein level and decreased apoptosis in the preserved liver grafts. In conclusion, we showed that the use of Ang IV in Celsior solution for sub-normothermic graft preservation insured a better NO-dependent relaxation and improved liver functional recovery.
Collapse
Affiliation(s)
- Donia Tabka
- Unité de Biologie et Anthropologie Moléculaire Appliquées au Développement et à la Santé (UR12ES11), Faculté de Pharmacie, Université de Monastir, Monastir, Tunisia
| | - Mohamed Bejaoui
- Unité de Biologie et Anthropologie Moléculaire Appliquées au Développement et à la Santé (UR12ES11), Faculté de Pharmacie, Université de Monastir, Monastir, Tunisia
| | - James Javellaud
- INSERM, Unité Mixte de Recherche S-850, 8000 Limoges, France
| | | | - Hassen Ben Abdennebi
- Unité de Biologie et Anthropologie Moléculaire Appliquées au Développement et à la Santé (UR12ES11), Faculté de Pharmacie, Université de Monastir, Monastir, Tunisia
| |
Collapse
|
72
|
Panisello-Roselló A, Verde E, Lopez A, Flores M, Folch-Puy E, Rolo A, Palmeira C, Hotter G, Carbonell T, Adam R, Roselló-Catafau J. Cytoprotective Mechanisms in Fatty Liver Preservation against Cold Ischemia Injury: A Comparison between IGL-1 and HTK. Int J Mol Sci 2018; 19:ijms19020348. [PMID: 29364854 PMCID: PMC5855570 DOI: 10.3390/ijms19020348] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/16/2018] [Accepted: 01/19/2018] [Indexed: 12/17/2022] Open
Abstract
Institute Goeorges Lopez 1 (IGL-1) and Histidine-Tryptophan-Ketoglutarate (HTK) preservation solutions are regularly used in clinical for liver transplantation besides University of Wisconsin (UW) solution and Celsior. Several clinical trials and experimental works have been carried out comparing all the solutions, however the comparative IGL-1 and HTK appraisals are poor; especially when they deal with the underlying protection mechanisms of the fatty liver graft during cold storage. Fatty livers from male obese Zücker rats were conserved for 24 h at 4 °C in IGL-1 or HTK preservation solutions. After organ recovery and rinsing of fatty liver grafts with Ringer Lactate solution, we measured the changes in mechanistic target of rapamycin (mTOR) signaling activation, liver autophagy markers (Beclin-1, Beclin-2, LC3B and ATG7) and apoptotic markers (caspase 3, caspase 9 and TUNEL). These determinations were correlated with the prevention of liver injury (aspartate and alanine aminostransferase (AST/ALT), histology) and mitochondrial damage (glutamate dehydrogenase (GLDH) and confocal microscopy findings). Liver grafts preserved in IGL-1 solution showed a marked reduction on p-TOR/mTOR ratio when compared to HTK. This was concomitant with significant increased cyto-protective autophagy and prevention of liver apoptosis, including inflammatory cytokines such as HMGB1. Together, our results revealed that IGL-1 preservation solution better protected fatty liver grafts against cold ischemia damage than HTK solution. IGL-1 protection was associated with a reduced liver damage, higher induced autophagy and decreased apoptosis. All these effects would contribute to limit the subsequent extension of reperfusion injury after graft revascularization in liver transplantation procedures.
Collapse
Affiliation(s)
- Arnau Panisello-Roselló
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC), 08036 Barcelona, Catalonia, Spain.
| | - Eva Verde
- Department of Cell Biology, Physiology and Immunology, Universitat de Barcelona, Barcelona, 08028 Catalonia, Spain.
| | - Alexandre Lopez
- Centre Hépato-Biliaire, AP-PH, Hôpital Paul Brousse, 94800 Villejuif, France.
| | - Marta Flores
- Department of Cell Biology, Physiology and Immunology, Universitat de Barcelona, Barcelona, 08028 Catalonia, Spain.
| | - Emma Folch-Puy
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC), 08036 Barcelona, Catalonia, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain.
| | - Anabela Rolo
- Center for Neuroscience and Cell Biology, Universidade Coimbra, 3000-370 Coimbra, Portugal.
| | - Carlos Palmeira
- Center for Neuroscience and Cell Biology, Universidade Coimbra, 3000-370 Coimbra, Portugal.
| | - Georgina Hotter
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC), 08036 Barcelona, Catalonia, Spain.
| | - Teresa Carbonell
- Department of Cell Biology, Physiology and Immunology, Universitat de Barcelona, Barcelona, 08028 Catalonia, Spain.
| | - René Adam
- Centre Hépato-Biliaire, AP-PH, Hôpital Paul Brousse, 94800 Villejuif, France.
| | - Joan Roselló-Catafau
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC), 08036 Barcelona, Catalonia, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Catalonia, Spain.
| |
Collapse
|
73
|
First Report of Human Pancreas Transplantation Using IGL-1 Preservation Solution: A Case Series. Transplantation 2018; 100:e46-7. [PMID: 27163542 DOI: 10.1097/tp.0000000000001242] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
74
|
Chedid MF, Bosi HR, Chedid AD, Alvares-da-Silva MR, Leipnitz I, Grezzana-Filho TJM, Reis MJ, Filho GM, Ghissi AJ, Neto PR, de Araujo A, Arruda S, Lopes AB, Michalczuk MT, Backes AN, Kruel CDP, Kruel CRP. One Hundred Consecutive Liver Transplants Using Institutes Georges Lopez-1 Preservation Solution: Outcomes and Prognostic Factors. Transplant Proc 2017; 49:848-851. [PMID: 28457409 DOI: 10.1016/j.transproceed.2017.01.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are only 4 prior studies reporting on outcomes of liver transplantation (LT) using Institutes Georges Lopez-1 (IGL-1) preservation solution. Detection of negative predictors of LT using IGL-1 may help finding strategies to protect selected recipients at higher risk of graft failure and death. METHODS Review of all consecutive adult patients who underwent a first whole-graft LT using IGL-1 at authors' institution from 2013 to 2016. Primary end point was graft failure within the first 90 postoperative days (PODs). Graft losses due to any cause (including all deaths with a functioning graft) were recorded as graft failures. RESULTS Of all 100 patients included in this study, 37 were women; median age was 58 years (range 18-71). There were 12 graft losses during the first 90 PODs (including 3 cases of primary nonfunction of the liver allograft), and 10 of the 12 graft losses occurred on first 30 PODs. All 12 patients who experienced graft loss (including 1 patient who underwent liver retransplantation) died within the first 90 PODs. Of the total 100 patients, 14 experienced biliary complications. Univariate analysis revealed prolonged warm ischemic time (WIT) as the only predictor of 90-day graft failure (odds ratio = 23.5, confidence interval = 1.29-430.18, P = .03). The cutoff by receiver operating characteristic curve for WIT was 38 minutes (area under the curve = 0.70). Positive predictive value for WIT >38 minutes was 94.3%. CONCLUSIONS LT using IGL-1 can be performed safely. Similar to prior reports on LT using other preservation solutions, prolonged WIT was associated with adverse outcomes.
Collapse
Affiliation(s)
- M F Chedid
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
| | - H R Bosi
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - A D Chedid
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - M R Alvares-da-Silva
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - I Leipnitz
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - T J M Grezzana-Filho
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - M J Reis
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - G M Filho
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - A J Ghissi
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - P R Neto
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - A de Araujo
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - S Arruda
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - A B Lopes
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - M T Michalczuk
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - A N Backes
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - C D P Kruel
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - C R P Kruel
- Liver Transplant Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| |
Collapse
|
75
|
Zaouali MA, Panisello A, Lopez A, Folch E, Castro-Benítez C, Adam R, Roselló-Catafau J. Cross-Talk Between Sirtuin 1 and High-Mobility Box 1 in Steatotic Liver Graft Preservation. Transplant Proc 2017; 49:765-769. [PMID: 28457391 DOI: 10.1016/j.transproceed.2017.01.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sirtuin 1 (SIRT1) is a nicotinamide adenine dinucleotide +-dependent histone deacetylase that regulates various pathways involved in ischemia-reperfusion injury (IRI). Moreover, high-mobility group box 1 protein (HMGB1) has also been involved in inflammatory processes during IRI. However, the roles of both SIRT1 and HMGB1 in liver preservation is poorly understood. In this communication, we evaluated the potential relationship between SIRT1 and HMGB1 in steatotic and non-steatotic liver grafts preserved in Institute Georges Lopez solution (IGL-1) preservation solution enriched or not enriched with trimetazidine (TMZ). METHODS Steatotic and non-steatotic livers were preserved in IGL-1 preservation solution (24 hours, 4°C), enriched or not enriched with TMZ (10 μmol/L), and then submitted to ex vivo reperfusion (2 hours; 37°C). Liver injury (AST/ALT) and function (bile output, vascular resistance) were evaluated. SIRT1, HMGB1, autophagy parameters (beclin-1, LC3B), PPAR-γ, and heat-shock protein (HO-1, HSP70) expression were determined by means of Western blot. Also, we assessed oxidative stress, mitochondrial damage (glutamate dehydrogenase), and TNF-α levels. RESULTS Elevated SIRT1 and enhanced autophagy were found after reperfusion in steatotic livers preserved in IGL-1+TMZ when compared with IGL-1. However, these changes were not seen in the case of non-steatotic livers. Also, HO-1 increases in the IGL-1 + TMZ group were evident only in the case of steatotic livers, whereas HSP70 and PPAR-γ protein expression were enhanced only in non-steatotic livers. All reported changes were consistent with decreased liver injury diminution, ameliorated hepatic function, and decreased TNF-α and HMGB levels. In addition, the oxidative stress and mitochondrial damage were efficiently prevented by the IGL-1 + TMZ use. CONCLUSIONS SIRT1 is associated with HMGB1 decreases and increased autophagy in steatotic livers, contributing to increased tolerance to cold IRI.
Collapse
Affiliation(s)
- M A Zaouali
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), CSIC-IDIBAPS, Barcelona, Spain; Research Unit of Biology and Molecular Anthropology Applied to Development and Health (UR12ES11), Faculty of Pharmacy, University of Monastir, Tunisia; High Institut of Biotechnology of Monastir, University of Monastir, Tunisia
| | - A Panisello
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), CSIC-IDIBAPS, Barcelona, Spain
| | - A Lopez
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Villejuif, France
| | - E Folch
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), CSIC-IDIBAPS, Barcelona, Spain
| | - C Castro-Benítez
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Villejuif, France
| | - R Adam
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Villejuif, France
| | - J Roselló-Catafau
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), CSIC-IDIBAPS, Barcelona, Spain.
| |
Collapse
|
76
|
Hameed AM, Laurence JM, Lam VWT, Pleass HC, Hawthorne WJ. A systematic review and meta-analysis of cold in situ perfusion and preservation of the hepatic allograft: Working toward a unified approach. Liver Transpl 2017; 23:1615-1627. [PMID: 28734125 PMCID: PMC5725662 DOI: 10.1002/lt.24829] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/03/2017] [Accepted: 07/16/2017] [Indexed: 01/01/2023]
Abstract
The efficacy of cold in situ perfusion and static storage of the liver is a possible determinant of transplantation outcomes. The aim of this study was to determine whether there is evidence to substantiate a preference for a particular perfusion route (aortic or dual) or perfusion/preservation solution in donation after brain death (DBD) liver transplantation. The Embase, MEDLINE, and Cochrane databases were used (1980-2017). Random effects modeling was used to estimate effects on transplantation outcomes based on (1) aortic or dual in situ perfusion and (2) the use of University of Wisconsin (UW), histidine tryptophan ketoglutarate (HTK), Celsior, and/or Institut Georges Lopez-1 (IGL-1) solutions for perfusion/preservation. A total of 22 articles were included (2294 liver transplants). The quality of evidence ranged from very low to moderate Grading of Recommendations, Assessment, Development and Evaluations score. Meta-analyses were conducted for 14 eligible studies. Although there was no difference in the primary nonfunction (PNF) rate, a higher peak alanine aminotransferase (ALT) was recorded in dual compared with aortic-only UW-perfused livers (standardized mean difference, 0.24; 95% confidence interval, 0.01-0.47); a back-table portal venous flush was undertaken in the majority of aortic-only perfused livers. There were no relevant differences in peak enzymes, PNF, thrombotic graft loss, biliary complications, or 1-year graft survival in comparisons between dual-perfused livers using UW, HTK, Celsior, or IGL-1. In conclusion, there is no significant evidence that aortic-only perfusion of the DBD liver compromises transplantation outcomes, and it may be favored because of its simplicity. However, there is currently insufficient evidence to advocate for the use of any particular perfusion/preservation fluid over the others. Liver Transplantation 23 1615-1627 2017 AASLD.
Collapse
Affiliation(s)
- Ahmer M. Hameed
- Centre for Transplant and Renal Research, Westmead Institute for Medical ResearchWestmeadNew South WalesAustralia,Department of SurgeryWestmead HospitalWestmeadNew South WalesAustralia,Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Jerome M. Laurence
- Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia,Department of Surgery,Institute of Academic Surgery, Royal Prince Alfred HospitalUniversity of SydneyCamperdownNew South WalesAustralia
| | - Vincent W. T. Lam
- Department of SurgeryWestmead HospitalWestmeadNew South WalesAustralia,Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Henry C. Pleass
- Department of SurgeryWestmead HospitalWestmeadNew South WalesAustralia,Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia,Department of Surgery
| | - Wayne J. Hawthorne
- Centre for Transplant and Renal Research, Westmead Institute for Medical ResearchWestmeadNew South WalesAustralia,Department of SurgeryWestmead HospitalWestmeadNew South WalesAustralia,Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
| |
Collapse
|
77
|
Hameed AM, Wong G, Laurence JM, Lam VWT, Pleass HC, Hawthorne WJ. A systematic review and meta-analysis of cold in situ perfusion and preservation for pancreas transplantation. HPB (Oxford) 2017; 19:933-943. [PMID: 28844527 DOI: 10.1016/j.hpb.2017.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study aimed to identify the most effective solution for in situ perfusion/preservation of the pancreas in donation after brain death donors, in addition to optimal in situ flush volume(s) and route(s) during pancreas procurement. METHODS Embase, Medline and Cochrane databases were utilized (1980-2017). Articles comparing graft outcomes between two or more different perfusion/preservation fluids (University of Wisconsin (UW), histidine-tryptophan-ketoglutarate (HTK) and/or Celsior) were compared using random effects models where appropriate. RESULTS Thirteen articles were included (939 transplants). Confidence in available evidence was low. A higher serum peak lipase (standardized mean difference 0.47, 95% CI 0.23-0.71, I2 = 0) was observed in pancreatic grafts perfused/preserved with HTK compared to UW, but there were no differences in one-month pancreas allograft survivals or early thrombotic graft loss rates. Similarly, there were no significant differences in the rates of graft pancreatitis, thrombosis and graft survival between UW and Celsior solutions, and between aortic-only and dual aorto-portal perfusion. CONCLUSION UW cold perfusion may reduce peak serum lipase, but no quality evidence suggested UW cold perfusion improves graft survival and reduces thrombosis rates. Further research is needed to establish longer-term graft outcomes, the comparative efficacy of Celsior, and ideal perfusion volumes.
Collapse
Affiliation(s)
- Ahmer M Hameed
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Department of Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Germaine Wong
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jerome M Laurence
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Vincent W T Lam
- Department of Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Henry C Pleass
- Department of Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Wayne J Hawthorne
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Department of Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
78
|
Takahashi K, Nagai S, Putchakayala KG, Safwan M, Gosho M, Li AY, Kane WJ, Singh PL, Rizzari MD, Collins KM, Yoshida A, Abouljoud MS, Schnickel GT. Prediction of biliary anastomotic stricture after deceased donor liver transplantation: the impact of platelet counts - a retrospective study. Transpl Int 2017; 30:1032-1040. [PMID: 28605573 DOI: 10.1111/tri.12996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/13/2017] [Accepted: 06/01/2017] [Indexed: 12/29/2022]
Abstract
Biliary stricture is a common cause of morbidity after liver transplantation (LT). This study aimed to determine the risk factors for post-transplant biliary anastomotic strictures (BAS), focusing on perioperative platelet counts. We enrolled 771 consecutive recipients who underwent ABO-identical/compatible deceased donor LT with duct-to-duct biliary reconstruction from January 2000 to June 2012. BAS was identified in 142 cases. The median time for stricture development was 176 days. Preoperative and postoperative platelet counts within 5 days after LT were significantly lower in patients with BAS than those without BAS. Using cutoff values acquired by the receiver operating characteristic curve analysis, persistent postoperative thrombocytopenia was defined as platelet counts <41 × 1000/μl and <53 × 1000/μl on postoperative day (POD) 3 and POD 5, respectively. Multivariate analysis indicated persistent postoperative thrombocytopenia (OR = 2.38) was the only independent risk factor for BAS. No significant associations were observed in terms of donor and surgical factors. Multivariate analysis demonstrated estimated blood loss (OR = 1.01, per 100 ml) was an independent contributing factor for persistent postoperative thrombocytopenia. We demonstrated low platelet count was associated with progression of post-transplant BAS. Minimizing intraoperative blood loss potentially contributes to maintain post-transplant platelet count, which may reduce incidence of BAS.
Collapse
Affiliation(s)
- Kazuhiro Takahashi
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Shunji Nagai
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Krishna G Putchakayala
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Mohamed Safwan
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Masahiko Gosho
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Amy Y Li
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - William J Kane
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Priyanka L Singh
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Michael D Rizzari
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Kelly M Collins
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Atsushi Yoshida
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Marwan S Abouljoud
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Gabriel T Schnickel
- Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, USA
| |
Collapse
|
79
|
Zaouali MA, Panisello-Roselló A, Lopez A, Castro Benítez C, Folch-Puy E, García-Gil A, Carbonell T, Adam R, Roselló-Catafau J. Relevance of proteolysis and proteasome activation in fatty liver graft preservation: An Institut Georges Lopez-1 vs University of Wisconsin appraisal. World J Gastroenterol 2017; 23:4211-4221. [PMID: 28694661 PMCID: PMC5483495 DOI: 10.3748/wjg.v23.i23.4211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/08/2017] [Accepted: 06/01/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To compare liver proteolysis and proteasome activation in steatotic liver grafts conserved in University of Wisconsin (UW) and Institut Georges Lopez-1 (IGL-1) solutions.
METHODS Fatty liver grafts from male obese Zücker rats were conserved in UW and IGL-1 solutions for 24 h at 4 °Cand subjected to “ex vivo” normo-thermic perfusion (2 h; 37 °C). Liver proteolysis in tissue specimens and perfusate was measured by reverse-phase high performance liquid chromatography. Total free amino acid release was correlated with the activation of the ubiquitin proteasome system (UPS: measured as chymotryptic-like activity and 20S and 19S proteasome), the prevention of liver injury (transaminases), mitochondrial injury (confocal microscopy) and inflammation markers (TNF 1 alpha, high mobility group box-1 (HGMB-1) and PPAR gamma), and liver apoptosis (TUNEL assay, cytochrome c and caspase 3).
RESULTS Profiles of free AA (alanine, proline, leucine, isoleucine, methionine, lysine, ornithine, and threonine, among others) were similar for tissue and reperfusion effluent. In all cases, the IGL-1 solution showed a significantly higher prevention of proteolysis than UW (P < 0.05) after cold ischemia reperfusion. Livers conserved in IGL-1 presented more effective prevention of ATP-breakdown and more inhibition of UPS activity (measured as chymotryptic-like activity). In addition, the prevention of liver proteolysis and UPS activation correlated with the prevention of liver injury (AST/ALT) and mitochondrial damage (revealed by confocal microscopy findings) as well as with the prevention of inflammatory markers (TNF1alpha and HMGB) after reperfusion. In addition, the liver grafts preserved in IGL-1 showed a significant decrease in liver apoptosis, as shown by TUNEL assay and the reduction of cytochrome c, caspase 3 and P62 levels.
CONCLUSION Our comparison of these two preservation solutions suggests that IGL-1 helps to prevent ATP breakdown more effectively than UW and subsequently achieves a higher UPS inhibition and reduced liver proteolysis.
Collapse
|
80
|
de Vries Y, von Meijenfeldt FA, Porte RJ. Post-transplant cholangiopathy: Classification, pathogenesis, and preventive strategies. Biochim Biophys Acta Mol Basis Dis 2017. [PMID: 28645651 DOI: 10.1016/j.bbadis.2017.06.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Biliary complications are the most frequent cause of morbidity, re-transplantation, and even mortality after liver transplantation. In general, biliary leakage and anastomotic and non-anastomotic biliary strictures (NAS) can be recognized. There is no consensus on the exact definition of NAS and different names and criteria have been used in literature. We propose to use the term post-transplant cholangiopathy for the spectrum of abnormalities of large donor bile ducts, that includes NAS, but also intraductal casts and intrahepatic biloma formation, in the presence of a patent hepatic artery. Combinations of these manifestations of cholangiopathy are not infrequently found in the same liver and ischemia-reperfusion injury is generally considered the common underlying mechanism. Other factors that contribute to post-transplant cholangiopathy are biliary injury due to bile salt toxicity and immune-mediated injury. This review provides an overview of the various types of post-transplant cholangiopathy, the presumed pathogenesis, clinical implications, and preventive strategies.
Collapse
Affiliation(s)
- Yvonne de Vries
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Fien A von Meijenfeldt
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert J Porte
- Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
| |
Collapse
|
81
|
Prieto I, Monsalve M. ROS homeostasis, a key determinant in liver ischemic-preconditioning. Redox Biol 2017; 12:1020-1025. [PMID: 28511345 PMCID: PMC5430574 DOI: 10.1016/j.redox.2017.04.036] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/26/2017] [Accepted: 04/29/2017] [Indexed: 02/07/2023] Open
Abstract
Reactive Oxygen Species (ROS) are key mediators of ischemia-reperfusion injury but also required for the induction of the stress response that limits tissue injury and underlies the protection provided by ischemic-preconditioning protocols. Liver steatosis is an important risk factor for liver transplant failure. Liver steatosis is associated with mitochondrial dysfunction and excessive mitochondrial ROS production. Studies aiming at decreasing the sensibility of the steatotic liver to ischemia-reperfusion injury using pre-conditioning protocols, have shown that the steatotic liver has a reduced capacity to respond to these protocols. Recent studies indicate that these effects are related to a reduced capacity of the steatotic liver to respond to elevated ROS levels following reperfusion by inducing a compensatory response. This failure to respond to ROS is associated with reduced levels of antioxidants, mitochondrial damage, hepatocyte cell death, activation of the immune system and induction of pro-fibrotic mediators.
Collapse
Affiliation(s)
- Ignacio Prieto
- Instituto de Investigaciones Biomédicas "Alberto Sols" (CSIC-UAM), Arturo Duperier 4, 28029 Madrid, Spain
| | - María Monsalve
- Instituto de Investigaciones Biomédicas "Alberto Sols" (CSIC-UAM), Arturo Duperier 4, 28029 Madrid, Spain.
| |
Collapse
|
82
|
Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group. Transplantation 2017; 101:S1-S56. [PMID: 28328734 DOI: 10.1097/tp.0000000000001651] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes.COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant.The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting.
Collapse
|
83
|
Reigada CHP, de Ataide EC, Mattosinho TDAP, Costa LBE, Escanhoela CA, Boin IFSF. Association Safety of Liver Preservation Solutions at the State University of Campinas From 2010 to 2014. Transplant Proc 2017; 49:761-764. [PMID: 28457390 DOI: 10.1016/j.transproceed.2017.01.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The probable reason for mixing solutions during the harvesting procedure is due to the presence of multiple transplant teams that have their own solution usage tradition. Despite numerous studies comparing the efficacy of different preservation solutions, there is no study addressing the associating solution and if there is any impact on liver graft and patient survival. The aim was to evaluate the effect of the association of preservation solutions during the harvesting procedure on liver transplantation outcomes, especially in relation to the degree of preservation injury in the postreperfusion period and patient survival. We analyzed 206 transplants that were distributed as follows: when there was association (89/206 = 43.2%) and when there was no association (117/206 = 56.8%). There was a statistically significant difference in relation to the degree of preservation injury correlated to cold ischemia time (P = .009, odds ratio 1.992; 95% confidence interval 1.185-3.347). Severe harvesting (grades III and IV) was 71.8% when the solution was not associated (P = .008). There was no difference regarding patient survival either. We found that the association of liver preservation solutions has no impact on patient survival, so it can be done safely. The best survival rate was associated with minimal harvesting.
Collapse
Affiliation(s)
- C H P Reigada
- Unit of Liver Transplantation, State University of Campinas, Brazil
| | - E C de Ataide
- Unit of Liver Transplantation, State University of Campinas, Brazil
| | | | - L B E Costa
- Department of Anatomical Pathology-State University of Campinas, Brazil
| | - C A Escanhoela
- Department of Anatomical Pathology-State University of Campinas, Brazil
| | - I F S F Boin
- Unit of Liver Transplantation, State University of Campinas, Brazil.
| |
Collapse
|
84
|
Skipworth JR, Spoletini G, Imber C. Surgical issues in retrieval and implantation. Br J Hosp Med (Lond) 2017; 78:266-272. [PMID: 28489438 DOI: 10.12968/hmed.2017.78.5.266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
With increasing demand for organ transplantation and patients deteriorating or dying on the waiting list, organs are now being increasingly used from donors previously considered too marginal. This requires improvements to donor management during the retrieval process, and of the organ during transport and subsequent implantation, in order to maintain outcomes.
Collapse
Affiliation(s)
- James Ra Skipworth
- Specialist Registrar, Hepatopancreaticobiliary and Liver Transplant Surgery, Department of Hepatopancreaticobiliary and Liver Transplant Surgery, Royal Free Hospital NHS Trust, London
| | - Gabriele Spoletini
- Senior Clinical Fellow, Hepatopancreaticobiliary and Liver Transplant Surgery, Department of Hepatopancreaticobiliary and Liver Transplant Surgery, Royal Free Hospital NHS Trust, London
| | - Charles Imber
- Consultant Hepatopancreaticobiliary and Liver Transplant Surgeon, Lead for Liver Transplant/National Organ Retrieval Service, Department of Hepatopancreaticobiliary and Liver Transplant Surgery, Royal Free Hospital NHS Trust, London NW3 2QG
| |
Collapse
|
85
|
Zaouali MA, Panisello A, Lopez A, Castro C, Folch E, Carbonell T, Rolo A, Palmeira CM, Garcia-Gil A, Adam R, Roselló-Catafau J. GSK3β and VDAC Involvement in ER Stress and Apoptosis Modulation during Orthotopic Liver Transplantation. Int J Mol Sci 2017; 18:ijms18030591. [PMID: 28282906 PMCID: PMC5372607 DOI: 10.3390/ijms18030591] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/20/2017] [Accepted: 02/23/2017] [Indexed: 01/07/2023] Open
Abstract
We investigated the involvement of glycogen synthase kinase-3β (GSK3β) and the voltage-dependent anion channel (VDAC) in livers subjected to cold ischemia-reperfusion injury (I/R) associated with orthotopic liver transplantation (OLT). Rat livers were preserved in University of Wisconsin (UW) and Institute Georges Lopez (IGL-1) solution, the latter enriched or not with trimetazidine, and then subjected to OLT. Transaminase (ALT) and HMGB1 protein levels, glutamate dehydrogenase (GLDH), and oxidative stress (MDA) were measured. The AKT protein kinase and its direct substrates, GSK3β and VDAC, as well as caspases 3, 9, and cytochrome C and reticulum endoplasmic stress-related proteins (GRP78, pPERK, ATF4, and CHOP), were determined by Western blot. IGL-1+TMZ significantly reduced liver injury. We also observed a significant phosphorylation of AKT, which in turn induced the phosphorylation and inhibition of GSK3β. In addition, TMZ protected the mitochondria since, in comparison with IGL-1 alone, we found reductions in VDAC phosphorylation, apoptosis, and GLDH release. All these results were correlated with decreased ER stress. Addition of TMZ to IGL-1 solution increased the tolerance of the liver graft to I/R injury through inhibition of GSK3β and VDAC, contributing to ER stress reduction and cell death prevention.
Collapse
Affiliation(s)
- Mohamed Amine Zaouali
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC), Barcelona 08036, Catalonia, Spain.
- Research Unit of Biology and Molecular Anthropology Applied to Development and Health (UR12ES11), Faculty of Pharmacy, University of Monastir, Monastir 5000, Tunisia.
- High Institute of Biotechnology of Monastir, University of Monastir, Monastir 5000, Tunisia.
| | - Arnau Panisello
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC), Barcelona 08036, Catalonia, Spain.
| | - Alexandre Lopez
- Centre Hépato-Biliaire, AP-PH, Hôpital Paul Brousse, Paris 94804, France.
| | - Carlos Castro
- Centre Hépato-Biliaire, AP-PH, Hôpital Paul Brousse, Paris 94804, France.
| | - Emma Folch
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC), Barcelona 08036, Catalonia, Spain.
| | - Teresa Carbonell
- Department of Physiology, Faculty of Biology, University of Barcelona, Barcelona 08028, Catalonia, Spain.
| | - Anabela Rolo
- Center of Neurosciences and Cell Biology, University of Coimbra, Coimbra 3004-504, Portugal.
| | - Carlos Marques Palmeira
- Center of Neurosciences and Cell Biology, University of Coimbra, Coimbra 3004-504, Portugal.
| | | | - René Adam
- Centre Hépato-Biliaire, AP-PH, Hôpital Paul Brousse, Paris 94804, France.
| | - Joan Roselló-Catafau
- Experimental Hepatic Ischemia-Reperfusion Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Spanish National Research Council (CSIC), Barcelona 08036, Catalonia, Spain.
| |
Collapse
|
86
|
Adam R, Cailliez V, Karam V. Evaluation of HTK Preservation Solutions in Liver Transplantation: A Long-Term Propensity-Based Analysis of Outcome From the European Liver Transplant Registry. Am J Transplant 2017; 17:585-586. [PMID: 27516047 DOI: 10.1111/ajt.14009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- R Adam
- Centre Hépatobiliaire, AP-HP Hôpital Paul Brousse, INSERM U 935, Univ Paris Sud, Villejuif, France
| | - V Cailliez
- Centre Hépatobiliaire, AP-HP Hôpital Paul Brousse, INSERM U 935, Univ Paris Sud, Villejuif, France
| | - V Karam
- Centre Hépatobiliaire, AP-HP Hôpital Paul Brousse, INSERM U 935, Univ Paris Sud, Villejuif, France
| |
Collapse
|
87
|
Wang TJ, Lin CH, Chang SN, Cheng SB, Chou CW, Chen CH, Shu KH, Wu MJ. Long-Term Outcome of Liver Transplant Recipients After the Development of Renal Failure Requiring Dialysis: A Study Using the National Health Insurance Database in Taiwan. Transplant Proc 2017; 48:1194-7. [PMID: 27320585 DOI: 10.1016/j.transproceed.2015.12.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/30/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND The aims of this study were to identify the incidence of renal failure requiring dialysis and to investigate the long-term outcome after renal failure in liver transplantation (LT) patients. METHODS The primary database used was the Taiwan National Health Insurance Research Database. Subjects with LT from 1997 to 2009 were included. Patients were grouped into the dialysis cohort if they once received hemodialysis owing to any pattern of renal failure during peri-transplantation periods or after LT. Otherwise, they were categorized into the nondialysis cohort. We conducted a retrospective observational study on the correlation of renal failure requiring dialysis and its effect on LT recipients. RESULTS The analysis included data of 1,771 LT recipients with a mean follow-up time of 3.8 ± 2.9 years. The mean age was 43.2 ± 19.3 years, and 69.4% were male. Overall patient survival was 86.2% at 1 year, 82.2% at 3 years, and 80.5% at 5 years. Renal failure requiring dialysis had developed in the 323 patients (18.2%). Among them, 26 individuals (1.5%) had progressed to end-stage renal disease without renal recovery after perioperative hemodialysis. Individuals who developed renal failure requiring dialysis had a higher mortality compared with LT recipients never requiring dialysis (hazard ratio, 8.75; 95% confidence interval, 7.0-10.9). CONCLUSIONS Renal failure requiring dialysis development after LT is common and carries high mortality in Chinese liver allograft recipients. Recognizing risk factors permits the timely institution of proper treatment, which is the key to reducing untoward outcomes.
Collapse
Affiliation(s)
- T-J Wang
- Division of Nephrology, Department of Internal Medicine, Chia-yi Branch, Taichung Veterans General Hospital, Taiwan; Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - C-H Lin
- Associate Investigator Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - S-N Chang
- Associate Investigator Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - S-B Cheng
- Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - C-W Chou
- Division of Hematology/Medical Oncology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - C-H Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; Center for Quality Management, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan
| | - K-H Shu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - M-J Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, College of Life Science, National Chung Hsing University, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taichung, Taiwan.
| |
Collapse
|
88
|
Massie I, Spaniol K, Geerling G, Schrader S. Cryopreservation and hypothermic storage of lacrimal gland: towards enabling delivery of regenerative medicine therapies for treatment of dry eye syndrome. J Tissue Eng Regen Med 2016; 11:3373-3384. [DOI: 10.1002/term.2251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 06/08/2016] [Accepted: 07/03/2016] [Indexed: 12/13/2022]
Affiliation(s)
- I. Massie
- Labor für Experimentelle Ophthalmologie; Universitätsklinikum Düsseldorf, Life Science Center; Düsseldorf Germany
| | - K. Spaniol
- Augenklinik, Universitätsklinikum Düsseldorf; Düsseldorf Germany
| | - G. Geerling
- Augenklinik, Universitätsklinikum Düsseldorf; Düsseldorf Germany
| | - S. Schrader
- Augenklinik, Universitätsklinikum Düsseldorf; Düsseldorf Germany
| |
Collapse
|
89
|
Gilbo N, Catalano G, Salizzoni M, Romagnoli R. Liver graft preconditioning, preservation and reconditioning. Dig Liver Dis 2016; 48:1265-1274. [PMID: 27448845 DOI: 10.1016/j.dld.2016.06.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/02/2016] [Accepted: 06/27/2016] [Indexed: 12/11/2022]
Abstract
Liver transplantation is the successful treatment of end-stage liver disease; however, the ischaemia-reperfusion injury still jeopardizes early and long-term post-transplant outcomes. In fact, ischaemia-reperfusion is associated with increased morbidity and graft dysfunction, especially when suboptimal donors are utilized. Strategies to reduce the severity of ischaemia-reperfusion can be applied at different steps of the transplantation process: organ procurement, preservation phase or before revascularization. During the donor procedure, preconditioning consists of pre-treating the graft prior to a sustained ischaemia either by a transient period of ischaemia-reperfusion or administration of anti-ischaemic medication, although a multi-pharmacological approach seems more promising. Different preservation solutions were developed to maintain graft viability during static cold storage, achieving substantial results in terms of liver function and survival in good quality organs but not in suboptimal ones. Indeed, preservation solutions do not prevent dysfunction of poor quality organs and are burdened with inadequate preservation of the biliary epithelium. Advantages derived from either hypo- or normothermic machine perfusion are currently investigated in experimental and clinical settings, suggesting a reconditioning effect possibly improving hepatocyte and biliary preservation and resuscitating graft function prior to transplantation. In this review, we highlight acquired knowledge and recent advances in liver graft preconditioning, preservation and reconditioning.
Collapse
Affiliation(s)
- Nicholas Gilbo
- Liver Transplantation Center, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Giorgia Catalano
- Liver Transplantation Center, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mauro Salizzoni
- Liver Transplantation Center, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Renato Romagnoli
- Liver Transplantation Center, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
| |
Collapse
|
90
|
Abstract
BACKGROUND The high demand for livers for transplantation has led to organs of limited quality being accepted to expand the donor pool. This is associated with inferior outcomes due to more pronounced preservation injury. Accordingly, recent research has aimed to develop preservation modalities for improved preservation as well as strategies for liver viability assessment and liver reconditioning. METHODS The PubMed database was searched using the terms 'perfusion', 'liver', 'preservation', and 'reconditioning' in various combinations, and the according literature was reviewed. RESULTS Several perfusion techniques have been developed in recent years with the potential for liver reconditioning. Preclinical and first emerging clinical data suggest feasibility, safety, and superiority over the current gold standard of cold storage. CONCLUSION This review outlines current advances in the field of liver preservation with an emphasis on liver reconditioning methods.
Collapse
Affiliation(s)
- Dieter P Hoyer
- General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - Thomas Minor
- General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| |
Collapse
|
91
|
Esteban-Zubero E, García-Gil FA, López-Pingarrón L, Alatorre-Jiménez MA, Ramírez JM, Tan DX, García JJ, Reiter RJ. Melatonin role preventing steatohepatitis and improving liver transplantation results. Cell Mol Life Sci 2016; 73:2911-27. [PMID: 27022943 PMCID: PMC11108472 DOI: 10.1007/s00018-016-2185-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/18/2016] [Indexed: 12/18/2022]
Abstract
Liver steatosis is a prevalent process that is induced due to alcoholic or non-alcoholic intake. During the course of these diseases, the generation of reactive oxygen species, followed by molecular damage to lipids, protein and DMA occurs generating organ cell death. Transplantation is the last-resort treatment for the end stage of both acute and chronic hepatic diseases, but its success depends on ability to control ischemia-reperfusion injury, preservation fluids used, and graft quality. Melatonin is a powerful endogenous antioxidant produced by the pineal gland and a variety of other because of its efficacy in organs; melatonin has been investigated to improve the outcome of organ transplantation by reducing ischemia-reperfusion injury and due to its synergic effect with organ preservation fluids. Moreover, this indolamine also prevent liver steatosis. That is important because this disease may evolve leading to an organ transplantation. This review summarizes the observations related to melatonin beneficial actions in organ transplantation and ischemic-reperfusion models.
Collapse
Affiliation(s)
- Eduardo Esteban-Zubero
- Department of Pharmacology and Physiology, University of Zaragoza, Calle Domingo Miral s/n, 50009, Saragossa, Spain.
| | - Francisco Agustín García-Gil
- Department of Surgery, Gynaecology and Obstetrics, University of Zaragoza, Calle Domingo Miral s/n, 50009, Saragossa, Spain
| | - Laura López-Pingarrón
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Calle Domingo Miral s/n, 50009, Saragossa, Spain
| | - Moisés Alejandro Alatorre-Jiménez
- Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - José Manuel Ramírez
- Department of Surgery, Gynaecology and Obstetrics, University of Zaragoza, Calle Domingo Miral s/n, 50009, Saragossa, Spain
| | - Dun-Xian Tan
- Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - José Joaquín García
- Department of Pharmacology and Physiology, University of Zaragoza, Calle Domingo Miral s/n, 50009, Saragossa, Spain
| | - Russel J Reiter
- Department of Cellular and Structural Biology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| |
Collapse
|
92
|
Pasut G, Panisello A, Folch-Puy E, Lopez A, Castro-Benítez C, Calvo M, Carbonell T, García-Gil A, Adam R, Roselló-Catafau J. Polyethylene glycols: An effective strategy for limiting liver ischemia reperfusion injury. World J Gastroenterol 2016; 22:6501-6508. [PMID: 27605884 PMCID: PMC4968129 DOI: 10.3748/wjg.v22.i28.6501] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/04/2016] [Accepted: 06/02/2016] [Indexed: 02/06/2023] Open
Abstract
Liver ischemia-reperfusion injury (IRI) is an inherent feature of liver surgery and liver transplantation in which damage to a hypoxic organ (ischemia) is exacerbated following the return of oxygen delivery (reperfusion). IRI is a major cause of primary non-function after transplantation and may lead to graft rejection, regardless of immunological considerations. The immediate response involves the disruption of cellular mitochondrial oxidative phosphorylation and the accumulation of metabolic intermediates during the ischemic period, and oxidative stress during blood flow restoration. Moreover, a complex cascade of inflammatory mediators is generated during reperfusion, contributing to the extension of the damage and finally to organ failure. A variety of pharmacological interventions (antioxidants, anti-cytokines, etc.) have been proposed to alleviate graft injury but their usefulness is limited by the local and specific action of the drugs and by their potential undesirable toxic effects. Polyethylene glycols (PEGs), which are non-toxic water-soluble compounds approved by the FDA, have been widely used as a vehicle or a base in food, cosmetics and pharmaceuticals, and also as adjuvants for ameliorating drug pharmacokinetics. Some PEGs are also currently used as additives in organ preservation solutions prior to transplantation in order to limit the damage associated with cold ischemia reperfusion. More recently, the administration of PEGs of different molecular weights by intravenous injection has emerged as a new therapeutic tool to protect liver grafts from IRI. In this review, we summarize the current knowledge concerning the use of PEGs as a useful target for limiting liver IRI.
Collapse
|
93
|
Hessheimer AJ, Cárdenas A, García-Valdecasas JC, Fondevila C. Can we prevent ischemic-type biliary lesions in donation after circulatory determination of death liver transplantation? Liver Transpl 2016; 22:1025-33. [PMID: 27082839 DOI: 10.1002/lt.24460] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/02/2016] [Indexed: 12/23/2022]
Abstract
The pool of livers for transplantation consists of an increasingly greater proportion of marginal grafts, in particular those arising through donation after circulatory determination of death (DCD). However, a primary factor limiting the use of marginal livers, and, thereby, the applicability of liver transplantation in general, is concern over the subsequent development of ischemic-type biliary lesion (ITBL). ITBL is a devastating complication of liver transplantation; in its most severe forms, recipients suffer frequent infectious complications that require repeated invasive biliary procedures and ultimately result in either retransplantation or death. In the present review article, we discuss our current understanding of ITBL pathogenesis as it pertains to DCD, in particular. We discuss the most relevant theories regarding its development and provide a comprehensive overview of the most promising strategies we have available today to prevent the appearance of ITBL, strategies that may, furthermore, allow us to transplant a greater proportion of marginal livers in the future. Liver Transplantation 22 1025-1033 2016 AASLD.
Collapse
Affiliation(s)
- Amelia J Hessheimer
- General and Digestive Surgery and, University of Barcelona, Barcelona, Spain
| | - Andrés Cárdenas
- Gastrointestinal/Liver Unit, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | | | | |
Collapse
|
94
|
Esteban-Zubero E, García-Gil FA, López-Pingarrón L, Alatorre-Jiménez MA, Iñigo-Gil P, Tan DX, García JJ, Reiter RJ. Potential benefits of melatonin in organ transplantation: a review. J Endocrinol 2016; 229:R129-46. [PMID: 27068700 DOI: 10.1530/joe-16-0117] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/11/2016] [Indexed: 12/14/2022]
Abstract
Organ transplantation is a useful therapeutic tool for patients with end-stage organ failure; however, graft rejection is a major obstacle in terms of a successful treatment. Rejection is usually a consequence of a complex immunological and nonimmunological antigen-independent cascade of events, including free radical-mediated ischemia-reperfusion injury (IRI). To reduce the frequency of this outcome, continuing improvements in the efficacy of antirejection drugs are a top priority to enhance the long-term survival of transplant recipients. Melatonin (N-acetyl-5-methoxytryptamine) is a powerful antioxidant and ant-inflammatory agent synthesized from the essential amino acid l-tryptophan; it is produced by the pineal gland as well as by many other organs including ovary, testes, bone marrow, gut, placenta, and liver. Melatonin has proven to be a potentially useful therapeutic tool in the reduction of graft rejection. Its benefits are based on its direct actions as a free radical scavenger as well as its indirect antioxidative actions in the stimulation of the cellular antioxidant defense system. Moreover, it has significant anti-inflammatory activity. Melatonin has been found to improve the beneficial effects of preservation fluids when they are enriched with the indoleamine. This article reviews the experimental evidence that melatonin is useful in reducing graft failure, especially in cardiac, bone, otolaryngology, ovarian, testicular, lung, pancreas, kidney, and liver transplantation.
Collapse
Affiliation(s)
| | | | - Laura López-Pingarrón
- Department of MedicinePsychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | | | - Pablo Iñigo-Gil
- Department of MedicinePsychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Dun-Xian Tan
- Department of Cellular and Structural BiologyUniversity of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - José Joaquín García
- Department of Pharmacology and PhysiologyUniversity of Zaragoza, Zaragoza, Spain
| | - Russel J Reiter
- Department of Cellular and Structural BiologyUniversity of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| |
Collapse
|
95
|
Schrem H, Focken M, Gunson B, Reichert B, Mirza D, Kreipe HH, Neil D, Kaltenborn A, Goldis A, Krauth C, Roberts K, Becker T, Klempnauer J, Neuberger J. The new liver allocation score for transplantation is validated and improved transplant survival benefit in Germany but not in the United Kingdom. Liver Transpl 2016; 22:743-56. [PMID: 26947766 DOI: 10.1002/lt.24421] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 12/27/2015] [Accepted: 01/11/2016] [Indexed: 12/13/2022]
Abstract
Prognostic models for the prediction of 90-day mortality after transplantation with pretransplant donor and recipient variables are needed to calculate transplant benefit. Transplants in adult recipients in Germany (Hannover, n = 770; Kiel, n = 234) and the United Kingdom (Birmingham, n = 829) were used for prognostic model design and validation in separate training and validation cohorts. The survival benefit of transplantation was estimated by subtracting the observed posttransplant 90-day mortality from the expected 90-day mortality without transplantation determined by the Model for End-Stage Liver Disease (MELD) score. A prognostic model called the liver allocation score (LivAS) was derived using a randomized sample from Hannover using pretransplant donor and recipient variables. This model could be validated in the German training and validation cohorts (area under the receiver operating characteristic curve [AUROC] > 0.70) but not in the English cohort (AUROC, 0.58). Although 90-day mortality rates after transplantation were 13.7% in Hannover, 12.1% in Kiel, and 8.3% in Birmingham, the calculated 90-day survival benefits of transplantation were 6.8% in Hannover, 7.8% in Kiel, and 2.8% in Birmingham. Deployment of the LivAS for limiting allocation to donor and recipient combinations with likely 90-day survival as indicated by pretransplant LivAS values below the cutoff value would have increased the survival benefit to 12.9% in the German cohorts, whereas this would have decreased the benefit in England to 1.3%. The English and German cohorts revealed significant differences in 21 of 28 pretransplant variables. In conclusion, the LivAS could be validated in Germany and may improve German allocation policies leading to greater survival benefits, whereas validation failed in England due to profound differences in the selection criteria for liver transplantation. This study suggests the need for national prognostic models. Even though the German centers had higher rates of 90-day mortality, estimated survival benefits were greater. Liver Transplantation 22 743-756 2016 AASLD.
Collapse
Affiliation(s)
- Harald Schrem
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation.,General, Visceral, and Transplant Surgery
| | - Moritz Focken
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation
| | - Bridget Gunson
- The Liver Unit and, Birmingham, United Kingdom.,Liver Biomedical Research Unit, National Institute for Health Research, University of Birmingham, United Kingdom
| | - Benedikt Reichert
- General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | | | | | - Desley Neil
- Pathology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Alexander Kaltenborn
- Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation.,Trauma and Orthopedic Surgery, Federal Armed Forces Hospital, Westerstede, Germany
| | - Alon Goldis
- Lean Six Sigma Black Belt, Amstelveen, Netherlands
| | - Christian Krauth
- Health Economics and Health Systems Research, Institute of Epidemiology, Social Medicine and Health Systems Research, Institute of Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Germany
| | | | - Thomas Becker
- General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital Schleswig Holstein, Kiel, Germany
| | | | - James Neuberger
- The Liver Unit and, Birmingham, United Kingdom.,Blood and Transplant, Organ Donation and Transplant, National Health Service, Bristol, United Kingdom
| |
Collapse
|
96
|
Folch-Puy E, Panisello A, Oliva J, Lopez A, Castro Benítez C, Adam R, Roselló-Catafau J. Relevance of Endoplasmic Reticulum Stress Cell Signaling in Liver Cold Ischemia Reperfusion Injury. Int J Mol Sci 2016; 17:807. [PMID: 27231901 PMCID: PMC4926341 DOI: 10.3390/ijms17060807] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 05/15/2016] [Accepted: 05/17/2016] [Indexed: 02/07/2023] Open
Abstract
The endoplasmic reticulum (ER) is involved in calcium homeostasis, protein folding and lipid biosynthesis. Perturbations in its normal functions lead to a condition called endoplasmic reticulum stress (ERS). This can be triggered by many physiopathological conditions such as alcoholic steatohepatitis, insulin resistance or ischemia-reperfusion injury. The cell reacts to ERS by initiating a defensive process known as the unfolded protein response (UPR), which comprises cellular mechanisms for adaptation and the safeguarding of cell survival or, in cases of excessively severe stress, for the initiation of the cell death program. Recent experimental data suggest the involvement of ERS in ischemia/reperfusion injury (IRI) of the liver graft, which has been considered as one of major problems influencing outcome after liver transplantation. The purpose of this review is to summarize updated data on the molecular mechanisms of ERS/UPR and the consequences of this pathology, focusing specifically on solid organ preservation and liver transplantation models. We will also discuss the potential role of ERS, beyond the simple adaptive response and the regulation of cell death, in the modification of cell functional properties and phenotypic changes.
Collapse
Affiliation(s)
- Emma Folch-Puy
- Experimental Pathology Department, Instituto de Investigaciones Biomédicas de Barcelona, Spanish Research Council (IIBB-CSIC), Rosselló 161, 08036-Barcelona, Catalonia, Spain.
| | - Arnau Panisello
- Experimental Pathology Department, Instituto de Investigaciones Biomédicas de Barcelona, Spanish Research Council (IIBB-CSIC), Rosselló 161, 08036-Barcelona, Catalonia, Spain.
| | - Joan Oliva
- Department of Medicine, LaBioMed at Harbor UCLA Medical Center, Torrance, 90502 CA, USA.
| | - Alexandre Lopez
- Centre Hépatobiliaire, AP-HP Hôpital Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, 75008 Paris, France.
| | - Carlos Castro Benítez
- Centre Hépatobiliaire, AP-HP Hôpital Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, 75008 Paris, France.
| | - René Adam
- Centre Hépatobiliaire, AP-HP Hôpital Paul Brousse, Inserm U935, Université Paris-Sud, Villejuif, 75008 Paris, France.
| | - Joan Roselló-Catafau
- Experimental Pathology Department, Instituto de Investigaciones Biomédicas de Barcelona, Spanish Research Council (IIBB-CSIC), Rosselló 161, 08036-Barcelona, Catalonia, Spain.
| |
Collapse
|
97
|
Klintmalm GBG. Organ Allocation: The Only Way to Predict Your Future Is to Know Your Past. Am J Transplant 2016; 16:383-4. [PMID: 26779868 DOI: 10.1111/ajt.13571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 09/20/2015] [Accepted: 10/06/2015] [Indexed: 01/25/2023]
Affiliation(s)
- G B G Klintmalm
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX
| |
Collapse
|
98
|
Grąt M, Wronka KM, Patkowski W, Stypułkowski J, Grąt K, Krasnodębski M, Masior Ł, Lewandowski Z, Krawczyk M. Effects of Donor Age and Cold Ischemia on Liver Transplantation Outcomes According to the Severity of Recipient Status. Dig Dis Sci 2016; 61:626-35. [PMID: 26499986 PMCID: PMC4729807 DOI: 10.1007/s10620-015-3910-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/28/2015] [Indexed: 02/07/2023]
Abstract
UNLABELLED BackgroundProlonged cold ischemic time (CIT) and increased donor age are well-known factors negatively influencing outcomes after liver transplantation (LT). AIMS The aim of this study was to evaluate whether the magnitude of their negative effects is related to recipient model for end-stage liver disease (MELD) score. METHODS This retrospective study was based on a cohort of 1402 LTs, divided into those performed in low-MELD (<10), moderate-MELD (10–20), and high-MELD (>20) recipients. RESULTS While neither donor age (p = 0.775) nor CIT (p = 0.561) was a significant risk factor for worse 5-year graft survival in low-MELD recipients, both were found to yield independent effects (p = 0.003 and p = 0.012, respectively) in moderate-MELD recipients, and only CIT (p = 0.004) in high-MELD recipients. However, increased donor age only triggered the negative effect of CIT in moderate-MELD recipients, which was limited to grafts recovered from donors aged ≥46 years (p = 0.019). Notably, utilization of grafts from donors aged ≥46 years with CIT ≥9 h in moderate-MELD recipients (p = 0.003) and those with CIT ≥9 h irrespective of donor age in high-MELD recipients (p = 0.031) was associated with particularly compromised outcomes. CONCLUSIONS In conclusion, the negative effects of prolonged CIT seem to be limited to patients with moderate MELD receiving organs procured from older donors and to high-MELD recipients, irrespective of donor age. Varying effects of donor age and CIT according to recipient MELD score should be considered during the allocation process in order to avoid high-risk matches.
Collapse
Affiliation(s)
- Michał Grąt
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Karolina M. Wronka
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Waldemar Patkowski
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Jan Stypułkowski
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Karolina Grąt
- />Second Department of Clinical Radiology, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Maciej Krasnodębski
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Łukasz Masior
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| | - Zbigniew Lewandowski
- />Department of Epidemiology, Medical University of Warsaw, 3 Oczki Street, 02-007 Warsaw, Poland
| | - Marek Krawczyk
- />Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, 1A Banacha Street, 02-097 Warsaw, Poland
| |
Collapse
|
99
|
Adam R, Delvart V, Karam V. Reply to Letter Regarding "Compared Efficacy of Preservation Solutions in Liver Transplantation: A Long-Term Graft Outcome Study From the European Liver Transplant Registry". Am J Transplant 2015; 15:3274-5. [PMID: 26555219 DOI: 10.1111/ajt.13512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 08/24/2015] [Accepted: 08/31/2015] [Indexed: 01/25/2023]
Affiliation(s)
- R Adam
- European Liver Transplant Registry Coordinating Committee, Centre Hepatobiliaire, AP-HP Hôpital Paul Brousse, INSERM U935, Université Paris Sud, Villejuif, France
| | - V Delvart
- European Liver Transplant Registry Coordinating Committee, Centre Hepatobiliaire, AP-HP Hôpital Paul Brousse, INSERM U935, Université Paris Sud, Villejuif, France
| | - V Karam
- European Liver Transplant Registry Coordinating Committee, Centre Hepatobiliaire, AP-HP Hôpital Paul Brousse, INSERM U935, Université Paris Sud, Villejuif, France
| |
Collapse
|
100
|
Nashan B, Spetzler V, Schemmer P, Kirste G, Rahmel A. Regarding "Compared Efficacy of Preservation Solutions in Liver Transplantation: A Long-Term Graft Outcome Study From the European Liver Transplant Registry". Am J Transplant 2015; 15:3272-3. [PMID: 26555321 DOI: 10.1111/ajt.13513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 06/17/2015] [Accepted: 07/15/2015] [Indexed: 01/25/2023]
Affiliation(s)
- B Nashan
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Transplantation Society (DTG), Regensburg, Germany.,Standing Committee Organ Transplantation, German Medical Association, Berlin, Germany
| | - V Spetzler
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Transplantation Society (DTG), Regensburg, Germany
| | - P Schemmer
- German Transplantation Society (DTG), Regensburg, Germany.,Department of General, Visceral and Transplant Surgery, Heidelberg, Germany
| | - G Kirste
- German Transplantation Society (DTG), Regensburg, Germany
| | - A Rahmel
- German Transplantation Society (DTG), Regensburg, Germany.,Standing Committee Organ Transplantation, German Medical Association, Berlin, Germany.,German Organ Transplantation Foundation (DSO), Frankfurt, Germany
| |
Collapse
|