BACKGROUND AND PROGNOSTIC IMPLICATIONS OF PERIREPERFUSION TISSUE-INJURIES IN HUMAN LIVER-TRANSPLANTS - A PANEL HISTOCHEMICAL-STUDY

Background. Hepatic graft reperfusion is associated with inflammatory processes of unknown relevance to the fate of graft. This study aimed to clarify this relevance by histochemical analyses of human hepatic g rafts. Methods. Paired tissue samples were taken at the end of cold pr eservation and 2 hr after reperfusion (n=39). From six additional graf ts, biopsies were performed at the end of cold preservation only. Inju ry or inflammatory markers of sinusoidal endothelium (von Willebrand f actor-related antigen [vWF]), Kupffer cells (25F9), platelets (CD62), neutrophil leukocytes (CD11b), interleukin (IL)-1 beta, intercellular adhesion molecule (ICAM)-1, and HLA-DR were evaluated semiquantitative ly by indirect immunoperoxidase staining. Steatosis was also evaluated by hematoxylin and eosin staining. Results. vWF, CD62(+) platelet agg regation, CD11b(+) leukocytes, and IL-1 beta levels increased after re perfusion, and these levels correlated with prereperfusion levels. Not only vWF, CD62(+) platelets, CD11b(+) leukocytes, IL-1 beta, ICAM-1, and steatosis after reperfusion, but also IL-1 beta, ICAM-1, and steat osis before reperfusion correlated with postoperative peak transaminas e. Furthermore, vWF, CD11b(+) leukocytes, 25F9(+) macrophages, and ICA M-1 after reperfusion were associated with primary graft nonfunction a nd strong expressions of ICAM-1 or HLA-DR with early acute rejection. Although some markers (IL-1 beta, CD62(+) platelets, and CD11b(+) leuk ocytes) correlated with preharvesting parameters (donor age or length of intensive care unit stay), none showed any significant correlation with cold preservation. Conclusion. Synergistic inflammatory events in the hepatic graft at reperfusion, which have a significant impact on the later clinical course, are largely defined and precipitated by inj ury or activation of nonparenchymal cells preceding reperfusion or eve n graft harvesting.