REPERFUSION INJURY, ANTIOXIDANTS AND HEMODYNAMICS DURING ORTHOTOPIC LIVER-TRANSPLANTATION

Endothelial injury occurs gs a result of oxygen free radical productio n after ischemia and reperfusion of transplanted livers, causing hemod ynamic disturbance. Patients with chronic liver disease generally have low levels of fat-soluble vitamins, which have important antioxidant roles. We therefore assessed circulating levels of the antioxidants vi tamin A, vitamin E, beta-carotene and lycopene, indices of lipid perox idation and hemodynamic changes during elective orthotopic liver trans plantation in 12 patients. We found that initial antioxidant levels we re severely depleted compared with healthy subjects, and in some patie nts carotene and lycopene levels were undetectable. Increased lipid pe roxidation was also evident, as shown by thiobarbituric acid-reactive substances. On reperfusion of the liver graft, vitamin A and E levels fell (p < 0.01) and were associated with decreases in systemic vascula r resistance (p < 0.02). These data show that patients undergoing live r transplant have lowered antioxidant defenses and evidence of free ra dical damage, which compound the additional insult of reperfusion inju ry. Antioxidant therapy in these patients before transplantation may a meliorate the effects of reperfusion.