CAN EFFLUENT HYALURONIC-ACID OR CREATINE-KINASE PREDICT SINUSOIDAL INJURY SEVERITY AFTER COLD ISCHEMIA

It is well recognized that current selection criteria used to assess l iver grafts before implantation are inaccurate and correlate poorly wi th graft outcome. A bench or laboratory-based test that could indicate the extent of liver injury immediately before implantation would be a valuable adjunct to clinical assessment. Hyaluronic acid (HA) and cre atine kinase (BB component; CK-BB) levels in the caval effluent after liver perfusion have been suggested as indicators of preservation inju ry. Our objective was to investigate the relevance of preserved liver effluent HA and CK-BB as a predictor of early graft function. Perfused liver effluent HA and CR-BB levels were measured. Graft function was measured in terms of peak serum aspartate transaminase and its level o n day 5 postoperatively as well as peak bilirubin level and prothrombi n time. The cold ischemia time (CIT) was recorded. Statistical compari sons were made among HA level, CK-BB level, CIT, and graft function pa rameters. The study was conducted at The Liver and Hepatobiliary Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom, Fifty patients undergoing OLT were studied. HA level was measured in 50 patients and CK-BB level in 30 patients. The main outcome measures were graft funct ion and graft outcome. The graft function data are grouped according t o effluent HA levels above or below 400 mu g/L. Thirteen patients (26% ) had a level below 400 mu g/L and the remaining 37 (74%) were above t his threshold. There were no significant differences between the group s for these indicators of graft function. There was no difference betw een the 2 groups for CIT. The overall median HA level was 1212 mu g/L (range 39-4000 mu g/L). The median total CK activity in the perfusate was 302 IU/L (range 118-1155 IU/L). The proportion of CK-BB activity f rom this total was 146 IU/L (8-641 IU/L), or 48% of the total CK activ ity. In a multiple regression analysis with CK-BB activity as the depe ndent variable, there was no demonstrable numerical relationship to gr aft function. In a separate multiple regression analysis similar resul ts were obtained for HA. We conclude that the level of HA or CK-BB lev els should not be used in determining the suitability for implantation of a harvested hepatic allograft.