Correlation between von Willebrand factor levels and early graft function in clinical liver transplantation

Cold preservation/reperfusion leads to sinusoidal endothelial cell (SEC) ac tivation and damage in nearly every liver transplantation; the extent of th ese changes influences early graft function. Upon reperfusion, activated SE C show increased expression of adhesion molecules, including von Willebrand factor (vWF) which is released into the circulation. This study was design ed to evaluate the levels of vWF measured in the caval effluent and correla te these findings with known markers of SEC damage and early graft function . Data were obtained from 35 patients undergoing orthotopic liver transplan tation (LTx). Two samples were taken from each patient for measurement of v WF: a) from the portal vein immediately prior to reperfusion; and b) from t he first 50 ml of the caval effluent. Commercial assays were used to measur e vWF, as well as hyaluronic acid (HA), thrombomodulin (TM), IL-1 beta, IL- 6, IL-8 and TNF-alpha. Patients were divided into two groups based on early graft function. Poor early graft function (PEGF) was defined as a peak asp artate transaminase (AST) or alanine transaminase (ALT) level > 2500 U/L du ring the first three postoperative days (POD) and a prothrombin time (PT) > 16 s on POD 2 (n = 8). The remaining 27 patients had good early graft func tion (GEGF). In patients with GEGF, vWF levels dropped significantly betwee n the two time points. This change was not observed in those with PEGF. A p ositive linear correlation was observed in the PEGF group between vWF and H A and IL-6. The different pattern of change in VWF between the two groups, as well as the positive correlation between HA, IL-6 and VWF in PEGF, sugge st that vWF may be a useful marker of early graft function.