Effects of 10 minutes of ischemic preconditioning of the cadaveric liver on the graft's preservation and function - The ying and the yang

Background Data: Although extensively studied in animal models, ischemic preconditioning has not yet been studied in clinical transplantation. Objective: To compare the results of cadaveric liver transplantation with and without ischemic liver preconditioning in the donor. Patients and Methods: Alternate patients were transplanted with liver grafts that had (n = 46, Group(Precond)) or had not (n = 45, Group(Control)) been subjected to ischemic preconditioning. Liver ischemia-reperfusion injury, liver and kidney function, morbidity, and in-hospital mortality rates were compared in the 2 groups. Initial poor function was defined as a minimal prothrombin time within 10 days of transplantation < 30% of normal and/or bilirubin > 200 mu mol/L. Results: The postoperative peaks of ASAT (IU/L) and ALAT (IU/L) were significantly lower in Group(Precond) (556 +/- 968 and 461 +/- 495, respectively) than in the Group(Control) (1073 +/- 1112 and 997 1071, respectively). The rate of technical morbidity and the incidence of acute rejection were similar in both groups. Initial poor function was significantly more frequent in the Group(Precond) (10 of 46 cases) than in the Group(Control),(3 of 45 cases). Hospital mortality rates were similar in the 2 groups. In multivariate analysis, body mass index of the donor, graft steatosis, and ischemic preconditioning were significantly predictive of the posttransplant peak of ASAT. In univariate analysis, only preconditioning was significantly associated with initial poor function. Conclusions: Compared with standard orthotopic liver transplant, ischemic preconditioning of the liver graft in the donor is associated with better tolerance to ischemia. However, this is at the price of decreased early function. Until further studies are available, the clinical value of preconditioning liver grafts remains uncertain.