TY - JOUR
T1 - Ischemia-reperfusion injury and its relationship with early allograft dysfunction in liver transplant patients
AU - Ito, Takahiro
AU - Naini, Bita V.
AU - Markovic, Daniela
AU - Aziz, Antony
AU - Younan, Stephanie
AU - Lu, Michelle
AU - Hirao, Hirofumi
AU - Kadono, Kentaro
AU - Kojima, Hidenobu
AU - DiNorcia, Joseph
AU - Agopian, Vatche G.
AU - Yersiz, Hasan
AU - Farmer, Douglas G.
AU - Busuttil, Ronald W.
AU - Kupiec-Weglinski, Jerzy W.
AU - Kaldas, Fady M.
N1 - Funding Information:
This work supported by National Institutes of Health grant P01 AI120944.
Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2021/2
Y1 - 2021/2
N2 - Ischemia-reperfusion injury (IRI) is believed to contribute to graft dysfunction after liver transplantation (LT). However, studies on IRI and the impact of early allograft dysfunction (EAD) in IRI grafts are limited. Histological IRI was graded in 506 grafts from patients who had undergone LT and classified based on IRI severity (no, minimal, mild, moderate, and severe). Of the 506 grafts, 87.4% had IRI (no: 12.6%, minimal: 38.1%, mild: 35.4%, moderate: 13.0%, and severe: 0.8%). IRI severity correlated with the incidence of EAD and graft survival at 6 months. Longer cold/warm ischemia time, recipient/donor hypertension, and having a male donor were identified as independent risk factors for moderate to severe IRI. Among 70 grafts with moderate to severe IRI, 42.9% of grafts developed EAD, and grafts with EAD had significantly inferior survival compared to grafts without EAD. Longer cold ischemia time and large droplet macrovesicular steatosis (≥20%) were identified as independent risk factors for EAD. Our study demonstrated that increased IRI severity was correlated with inferior short-term graft outcomes. Careful consideration of IRI risk factors during donor-recipient matching may assist in optimizing graft utilization and LT outcomes. Furthermore, identification of risk factors of IRI-associated EAD may guide patient management and possible timely graft replacement.
AB - Ischemia-reperfusion injury (IRI) is believed to contribute to graft dysfunction after liver transplantation (LT). However, studies on IRI and the impact of early allograft dysfunction (EAD) in IRI grafts are limited. Histological IRI was graded in 506 grafts from patients who had undergone LT and classified based on IRI severity (no, minimal, mild, moderate, and severe). Of the 506 grafts, 87.4% had IRI (no: 12.6%, minimal: 38.1%, mild: 35.4%, moderate: 13.0%, and severe: 0.8%). IRI severity correlated with the incidence of EAD and graft survival at 6 months. Longer cold/warm ischemia time, recipient/donor hypertension, and having a male donor were identified as independent risk factors for moderate to severe IRI. Among 70 grafts with moderate to severe IRI, 42.9% of grafts developed EAD, and grafts with EAD had significantly inferior survival compared to grafts without EAD. Longer cold ischemia time and large droplet macrovesicular steatosis (≥20%) were identified as independent risk factors for EAD. Our study demonstrated that increased IRI severity was correlated with inferior short-term graft outcomes. Careful consideration of IRI risk factors during donor-recipient matching may assist in optimizing graft utilization and LT outcomes. Furthermore, identification of risk factors of IRI-associated EAD may guide patient management and possible timely graft replacement.
KW - early allograft dysfunction
KW - graft survival
KW - ischemia-reperfusion injury
KW - liver biopsy
KW - liver steatosis
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U2 - 10.1111/ajt.16219
DO - 10.1111/ajt.16219
M3 - Article
C2 - 32713098
AN - SCOPUS:85090442569
SN - 1600-6135
VL - 21
SP - 614
EP - 625
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 2
ER -