Role of ischemic preconditioning and the portosystemic shunt in the prevention of liver and lung damage after rat liver transplantation

• Published in: Transplantation Vol. 76; no. 2; pp. 282 - 289
• Main Authors: FERNANDEZ, L, HEREDIA, N, GRANDE, L, PERALTA, C, XAUS, C, ROSELLO-CATAFAU, J, RIMOLA, A, MARCO, A, SERAFIN, A, DEULOFEU, R, GELPI, E
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 27-07-2003
• Subjects: Animals; Biological and medical sciences; Cold Temperature; Combined surgery. Multiple transplantations; Energy Metabolism; Hepatocytes - metabolism; Hepatocytes - pathology; Ischemic Preconditioning; Liver Diseases - pathology; Liver Diseases - prevention & control; Liver Diseases - surgery; Liver Transplantation; Lung Diseases - pathology; Lung Diseases - prevention & control; Male; Medical sciences; Portasystemic Shunt, Surgical; Postoperative Complications - pathology; Postoperative Complications - prevention & control; Rats; Rats, Sprague-Dawley; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tumor Necrosis Factor-alpha - metabolism; Nervous system diseases; Rat; Shunt; Lung; Rodentia; Cardiovascular disease; Hepatic disease; Transplantation; Homotransplantation; Respiratory system; Vascular disease; Prevention; Vertebrata; Mammalia; Treatment; Ischemia; Surgery; Animal; Digestive diseases; Graft; Lesion; Damage; Preconditioning
• ISSN: 0041-1337; 1534-6080
• DOI: 10.1097/01.TP.0000067529.82245.4E

This study evaluates whether surgical strategies such as the portosystemic shunt and ischemic preconditioning can protect against hepatic and pulmonary injury associated with liver transplantation.
The effect of the portosystemic shunt, ischemic preconditioning, and both surgical procedures together were evaluated in rat liver transplantation. Alanine aminotransferase, hyaluronic acid levels in plasma, adenosine triphosphate and nucleotide levels in liver and edema, malondialdehyde levels, and myeloperoxidase activity were measured 24 hr posttransplantation. Plasmatic tumor necrosis factor (TNF) levels were measured as a possible proinflammatory factor responsible for hepatic and pulmonary damage associated with liver transplantation.
Hepatocyte and cell endothelial damage were observed in liver grafts subjected to 8 hr of cold ischemia. This was associated with increased plasma TNF levels and lung inflammatory response. Portosystemic shunt application in the recipient protected endothelial cells but did not confer an effective protection from hepatocyte damage or reduce the increased plasma TNF levels and lung damage after liver transplantation. However, preconditioning of the donor liver conferred protection against both the endothelial cell and hepatocyte damage observed after liver transplantation. Preconditioning also attenuated the increased plasma TNF release and pulmonary damage. The combination of both surgical strategies resulted in levels of liver injury, TNF, and lung damage similar to those seen after liver transplantation.
These findings indicate that ischemic preconditioning could be a preferred treatment to reduce hepatic and pulmonary damage associated with liver transplantation. However, this strategy may not be effective in several clinical situations requiring a portosystemic shunt.