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Pulitano C, Ho P, Verran D, Sandroussi C, Joseph D, Bowen DG, McCaughan GW, Crawford M, Shackel N. Molecular profiling of postreperfusion milieu determines acute kidney injury after liver transplantation: A prospective study. Liver Transpl 2018; 24:922-931. [PMID: 29684255 DOI: 10.1002/lt.25178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 03/20/2018] [Accepted: 04/12/2018] [Indexed: 02/07/2023]
Abstract
Acute kidney injury (AKI) after liver transplantation (LT) is a common event, but its pathogenesis remains unclear. The aim of this prospective study is to investigate the potential relationship between postreperfusion gene expression, serum mediators, and the onset of AKI after LT. Sixty-five consecutive patients undergoing LT were included in the study. Reverse transcription polymerase chain reaction (PCR) was performed on liver biopsies. Gene expression of 23 genes involved in ischemia/reperfusion injury (IRI) was evaluated. The serum concentrations of endothelin (ET)-1 and inflammatory cytokines were analyzed. AKI after LT developed in 21 (32%) recipients (AKI group). Reverse transcription PCR of reperfusion biopsy in the AKI group showed higher expression of several genes involved in IRI compared with the non-AKI group. Fold changes in the gene expression of ET-1, interleukin (IL) 18, and tumor necrosis factor α (TNF-α) were associated with creatinine peak value. AKI patients also had significantly higher ET-1, IL18, and TNF-α postoperative serum levels. Multivariate analysis showed that ET-1 (odds ratio [OR], 16.7; 95% confidence interval [CI], 3.34-83.42; P = 0.001) and IL18 (OR, 5.27; 95% CI, 0.99-27.82, P = 0.048) serum levels on postoperative day 1 were independently predictive of AKI. Receiver operating characteristic analysis demonstrated that the combination of biomarkers ET-1+IL18 was highly predictive of AKI (area under the receiver operating characteristic curve, 0.91; 95% CI, 0.83-0.99). Early allograft dysfunction and chronic kidney disease stage ≥ 2 occurred more frequently in AKI patients. These results suggest that the graft itself, rather than intraoperative hemodynamic instability, plays a main role in AKI after LT. These data may have mechanistic and diagnostic implications for AKI after LT. Liver Transplantation 24 922-931 2018 AASLD.
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Affiliation(s)
- Carlo Pulitano
- Centenary Research Institute, University of Sydney, Sydney, New South Wales, Australia.,Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Center for Advanced Research in Liver Pancreas Biliary Surgery, Sydney, New South Wales, Australia
| | - Phong Ho
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Deborah Verran
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Charbel Sandroussi
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Center for Advanced Research in Liver Pancreas Biliary Surgery, Sydney, New South Wales, Australia
| | - David Joseph
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Center for Advanced Research in Liver Pancreas Biliary Surgery, Sydney, New South Wales, Australia
| | - David G Bowen
- Centenary Research Institute, University of Sydney, Sydney, New South Wales, Australia.,Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Geoffrey W McCaughan
- Centenary Research Institute, University of Sydney, Sydney, New South Wales, Australia.,Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Michael Crawford
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Center for Advanced Research in Liver Pancreas Biliary Surgery, Sydney, New South Wales, Australia
| | - Nicholas Shackel
- Centenary Research Institute, University of Sydney, Sydney, New South Wales, Australia.,Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Pulitano C, Joseph D, Sandroussi C, Verran D, Ho P, Debiasio A, Luongo A, McCaughan GW, Shackel NA, Crawford M. Postreperfusion microcirculatory derangements after liver transplantation: Relationship to hemodynamics, serum mediators, and outcome. Liver Transpl 2017; 23:527-536. [PMID: 28073175 DOI: 10.1002/lt.24721] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/22/2016] [Accepted: 12/08/2016] [Indexed: 02/06/2023]
Abstract
Despite the growing data supporting the role of microcirculation in regulating liver function, little of this knowledge has been translated into clinical practice. The aim of this study is to quantify hepatic microcirculation in vivo using sidestream dark field (SDF) imaging and correlate these findings with hepatic blood flow, hemodynamic parameters, and soluble mediators. Postreperfusion hepatic microcirculation was assessed using SDF imaging. Hepatic microcirculation measurements included functional sinusoidal density (cm/cm2 ), sinusoidal diameter (μm), red blood cell velocity (μm/second), volumetric blood flow (pl/second), and flow heterogeneity (FH) index. The serum concentrations of endothelin 1 (ET-1) and other inflammatory markers were analyzed with Luminex technology. Portal venous and hepatic artery flows were measured using a flowmeter. Twenty-eight patients undergoing cadaveric liver transplantations have been included in this study. Early allograft dysfunction (EAD) occurred in 7 (25%) patients and was associated with microcirculatory dysfunction. Low arterial and portal flow, high dose of inotropes, cold ischemia time, steatosis, and high ET-1 levels were all associated with impaired microcirculation. The time interval between portal venous and hepatic arterial reperfusion significantly correlated with the changes of the liver grafts' microcirculation. EAD patients tended to have higher serum levels of ET-1 on postoperative days 1, 2, 5, and 7 (all P < 0.01). Serum levels of ET-1 correlated significantly with microcirculation parameters. In conclusion, postreperfusion hepatic microcirculation is a determinant of organ dysfunction after liver reperfusion and could be used to identify very early patients at risk of EAD. Liver Transplantation 23 527-536 2017 AASLD.
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Affiliation(s)
- Carlo Pulitano
- Centenary Research Institute, University of Sydney, Sydney, NSW, Australia.,Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Center for Advanced Research in Liver Pancreas Biliary Surgery, Sydney, NSW, Australia
| | - David Joseph
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Center for Advanced Research in Liver Pancreas Biliary Surgery, Sydney, NSW, Australia
| | - Charbel Sandroussi
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Center for Advanced Research in Liver Pancreas Biliary Surgery, Sydney, NSW, Australia
| | - Deborah Verran
- Center for Advanced Research in Liver Pancreas Biliary Surgery, Sydney, NSW, Australia
| | - Phong Ho
- Center for Advanced Research in Liver Pancreas Biliary Surgery, Sydney, NSW, Australia
| | - Ashe Debiasio
- Center for Advanced Research in Liver Pancreas Biliary Surgery, Sydney, NSW, Australia
| | - Adriano Luongo
- Centenary Research Institute, University of Sydney, Sydney, NSW, Australia
| | - Geoffrey W McCaughan
- Centenary Research Institute, University of Sydney, Sydney, NSW, Australia.,Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nicholas A Shackel
- Centenary Research Institute, University of Sydney, Sydney, NSW, Australia.,Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Michael Crawford
- Australian National Liver Transplantation Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Center for Advanced Research in Liver Pancreas Biliary Surgery, Sydney, NSW, Australia
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Chaumais MC, Guignabert C, Savale L, Jaïs X, Boucly A, Montani D, Simonneau G, Humbert M, Sitbon O. Clinical pharmacology of endothelin receptor antagonists used in the treatment of pulmonary arterial hypertension. Am J Cardiovasc Drugs 2015; 15:13-26. [PMID: 25421754 DOI: 10.1007/s40256-014-0095-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a devastating life-threatening disorder characterized by elevated pulmonary vascular resistance leading to elevated pulmonary arterial pressures, right ventricular failure, and ultimately death. Vascular endothelial cells mainly produce and secrete endothelin (ET-1) in vessels that lead to a potent and long-lasting vasoconstrictive effect in pulmonary arterial smooth muscle cells. Along with its strong vasoconstrictive action, ET-1 can promote smooth muscle cell proliferation. Thus, ET-1 blockers have attracted attention as an antihypertensive drug, and the ET-1 signaling system has paved a new therapeutic avenue for the treatment of PAH. We outline the current understanding of not only the pathogenic role played by ET-1 signaling systems in the pathogenesis of PH but also the clinical pharmacology of endothelin receptor antagonists (ERA) used in the treatment of PAH.
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MESH Headings
- Animals
- Antihypertensive Agents/adverse effects
- Antihypertensive Agents/pharmacokinetics
- Antihypertensive Agents/therapeutic use
- Drug Interactions
- Drug Therapy, Combination/adverse effects
- Endothelin Receptor Antagonists/adverse effects
- Endothelin Receptor Antagonists/pharmacokinetics
- Endothelin Receptor Antagonists/therapeutic use
- Endothelins/antagonists & inhibitors
- Endothelins/metabolism
- Endothelium, Vascular/drug effects
- Endothelium, Vascular/immunology
- Endothelium, Vascular/metabolism
- Humans
- Hypertension, Pulmonary/drug therapy
- Hypertension, Pulmonary/immunology
- Hypertension, Pulmonary/metabolism
- Hypertension, Pulmonary/physiopathology
- Models, Biological
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/immunology
- Muscle, Smooth, Vascular/metabolism
- Practice Guidelines as Topic
- Pulmonary Circulation/drug effects
- Signal Transduction/drug effects
- Vasculitis/etiology
- Vasculitis/prevention & control
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Narin C, Kiris I, Gülmen S, Toy H, Yilmaz N, Sütcü R. Endothelin Receptor Blockade with Tezosentan Ameliorates Myocardial Injury Induced by Abdominal Aortic Ischemia-Reperfusion. TOHOKU J EXP MED 2008; 216:267-76. [DOI: 10.1620/tjem.216.267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Cüneyt Narin
- Department of Cardiovascular Surgery, Selcuk University Meram Medical School
| | - Ilker Kiris
- Department of Cardiovascular Surgery, Süleyman Demirel University Medical School
| | - Senol Gülmen
- Department of Cardiovascular Surgery, Süleyman Demirel University Medical School
| | - Hatice Toy
- Department of Pathology, Selcuk University Meram Medical School
| | - Nigar Yilmaz
- Department of Biochemistry, Süleyman Demirel University Medical School
| | - Recep Sütcü
- Department of Biochemistry, Süleyman Demirel University Medical School
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Abstract
Increasing numbers of experimental investigations and recently also of clinical trials strongly suggest an integral involvement of the endothelin (ET)-system in the pathophysiology of a variety of disease states, mainly of the cardiovascular system. Ambrisentan (LU 208075), a selective ET(A)-receptor antagonist, is an orally active diphenyl propionic acid derivative. It has been shown to have a very promising efficacy to safety ratio in the initial clinical trials. Phase II and Phase III trials with ambrisentan in pulmonary arterial hypertension have been performed. The pharmacological properties and data from the experimental investigations suggest additional possible uses of ambrisentan in the prevention of reperfusion injury after organ transplantation and in restenosis following coronary artery dilatation. Furthermore, the pharmacological profile of ambrisentan indicates that this drug may also be suitable in the treatment of cerebrovascular disorders. In the present article basic investigations, animal studies and clinical trials with ambrisentan are reviewed. This review may help to define pathophysiological conditions, in which ambrisentan could be indicated and further evaluated in appropriate preclinical and clinical trials.
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Affiliation(s)
- Hartmut Vatter
- Department of Neurosurgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
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