Effects of ischemia-reperfusion on hepatic glutathione and plasmatic markers of graft function during in situ split-liver transplantation in adult recipients

In situ split-liver transplantation is a new surgical technique where the b ipartition of a single liver allows procurement of a right graft (segments I, IV, V-VIII) for an adult recipient (75% of the total liver volume), and a left graft (segments II and III) for a child recipient. The present study was designed to assess the effects of ischemia-reperfusion on right grafts obtained by in situ split-liver transplantation. To this aim, hepatic glut athione and conventional plasmatic markers of allograft function (alanine a nd aspartate aminotransferase, total bilirubin, prothrombin time, lactate d ehydrogenase, gamma -glutamyltranspeptidase, and alkaline phosphatase) were evaluated in four adult recipients. At the time of reperfusion, a marked g lutathione decrease was found in the segment VI in three cases, whereas the amount of glutathione in segment IV was related to the duration of cold is chemia in all cases. Upon reperfusion, a marked increase in plasmatic alani ne aminotransferase, aspartate aminotransferase, and lactate dehydrogenase was found. A recovery in prothrombin time was observed from the first day i n three cases. An increasing trend in total bilirubin, gamma -glutamyltrans peptidase, and alkaline phosphatase was noted from the second day after tra nsplant. This preliminary study suggests a possible relationship between th e duration of cold ischemia, amount of glutathione in segment IV of the rig ht graft, and the trend in plasmatic markers of allograft damage during in situ split-liver transplantation in adult recipients.