Biological modulation of liver ischemia-reperfusion injury

Purpose of review This review gives a broad overview of the key factors of ischemic injury to the liver and presents the current modifications of preservation solutions and the few strategies of biological modulation in clinical use today. Recent findings Protective effects in human-liver transplantation were shown by methylprednisolone treatment in decreased donors, and by inhalation of a nontoxic dose of nitric oxide in recipients. In addition, recent results showed rescue of pig livers, donated after cardiac death by application of a cocktail of substances addressing several previously identified mechanisms of ischemia-reperfusion injury. Summary The future of a pharmacological approach attenuating or preventing ischemia-reperfusion injury lies in a combination of drugs acting simultaneously on several steps of the injury cascades. Applying these substances during flush, before, and during implantation appears as an attractive strategy to protect extended criteria liver grafts.