M. Glanemann, J. M. Langrehr
Clinical Results after Orthotopic Liver Transplantation Dependent on Ischemia/Reperfusion Injury

The underlying mechanisms of hepatic ischemia/reperfusion injury are complex and multifactorial. During ischemia, hepatocyte damage is caused by mitochondrial ATP-depletion and consecutive loss of cellular membrane integrity. Due to activation of Kupffer-cells and sinusoidal endothelial cell damage following reperfusion, an increase of endothelial-leukocyte and -thrombocyte interaction including sequestration of inflammatory cells into the interstitium is observed. In consequence, a local inflammatory tissue response and a decreased microcirculation may develop, resulting in ischemic infarction and loss of liver graft function.
The quality of the donor liver, which is dependent on the duration of prior intensive care stay of the donor and his nutritional status, as well as the cold ischemic time could be identified as risk factors for severe ischemia/reperfusion injury.
Based on a retrospective analysis of 889 liver transplantations, the duration of postoperative mechanical ventilation and hospitalisation were significantly increased in case of severe ischemia/reperfusion injury. Additionaly, severe ischemia/reperfusion injury significantly impaired patient and graft survival.
In summary, ischemia/reperfusion injury has a tremendeous impact on patient and graft outcome after clinical liver transplantation. Therefore, further advances to improve solid organ preservation, thereby minimizing liver graft I/R injury are required.

Key words: orthotopic liver transplantation, ischemia-reperfusion injury, patient survival, graft survival, risk factors, retransplantation, rejection

Dr. Matthias Glanemann
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie
Charité, Campus Virchow-Klinikum
Humboldt Universität Berlin
Augustenburger Platz 1
D-13353 Berlin
E-mail: matthias.glanemann@charite.de