*Purpose: Ischemia/reperfusion (I/R) injury following prolonged cold storage has a significant impact on early and late human liver transplantation (LTx) outcomes. Prevention of I/R injury would improve the outcome of LTx and potentially expand the limited donor pool by allowing the wider use of marginal organs. Intravenous immunoglobulin (IVIG) has immunomodulatory effects and has been shown to decrease rate of acute rejection in LTx recipients. However, the role of IVIG in prevention of I/R injury is unclear. The aim of this study is to examine if intraoperative IVIG administration would be protective against I/R injury after adult LTx.

*Methods: We conducted a retrospective study of deceased donor LTx recipients between 2017-2018 at our center. We compared recipients who received a dose of IVIG intraoperatively (IVIG group, median dose 500mg/kg, n=35) with recipients who did not (control group, n=34). We used the United Network of Organ Sharing data to obtain donor characteristic (age, gender, donation after circulatory death, serum ALT before donor surgery) and conducted chart review of recipients’ characteristic data (age, gender, Model for End-Stage Liver Disease Score, indication for LTx), intraoperative variables, postoperative data (serum transaminases, acute rejections, graft survival, patient survival) to compare clinical outcomes between the two groups.

*Results: Donor and recipient characteristics were similar between control and IVIG group. Operative time (402 minutes vs 386 minutes), estimated blood loss (2000ml vs 2525ml), units of transfusion (8 units vs 9 units), cold ischemia time (302 minutes vs 286 minutes), and warm ischemia time (31 minutes vs 31 minutes) were not statistically different (all expressed as median, p>0.05). There were no significant differences in intraoperative hemodynamic parameters (mean arterial, pulmonary artery, and central venous pressures) between the two group (p>0.05). Control group had significantly higher level of ALT at 3 hour (390±43 vs 257±28 U/L, p=0.007), 10 hours (359±50 vs 247±36 U/L, p=0.02), and AST at 3 hour (729±96 vs 451±39 U/L, p=0.005) after reperfusion compared to IVIG group; IVIG group had >30% reduction in I/R injury. There was no significant difference in the rate of acute rejection (p=0.47) and recipients` survival (p=0.25, Log rank).

*Conclusions: These novel data indicate that intraoperative IVIG administration may be protective against I/R injury after LTx. The result of this study would serve as a foundation for future prospective studies to determine the effect of IVIG in prevention of I/R injury after LTx.

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