Objectives:

Recently, hyaluronic acid (HA) levels of the solution during graft preservation has been reported to be associated with primary non function in deceased donor liver transplantation. However, it still remains unclear whether preoperative serum HA levels can predict the outcome after adult-to-adult living donor liver transplantation (LDLT).

Patients and Methods:

[Study I] Twenty-one patients who underwent LDLT (2002.3-2004.2) were divided into two groups according to the preoperative serum HA levels: H-I group: HA >/= 500 ng/ml (n = 12, median HA: 994 ng/ml) and L-I group: HA <500 ng/ml (n = 9, HA: 421 ng/ml). We retrospectively investigated the surgical results, hepatocyte growth factor (HGF) levels and patient survival. [Study II] Seventy seven LDLT patients (2004.5-2014.12) were also divided into two groups: H-II group:(n = 40, median HA: 3333 ng/ml) and L-II group: (n = 37, HA: 244 ng/ml), and were compared liver regeneration ratio based on CT Volumetry (liver volume at 1 months after LDLT / standard liver volume), survival and investigated the prognostic risk factor.

Results:

[Study I] There were no significant differences of surgical results.Serum HA levels were significantly higher in H-I group than in L-I group at 1, 3, 5, and 7 days after LDLT. Postoperative liver function tests and HGF levels were significantly higher in H-I group than those in L-I group (H-I v.s. L-I: peak T-bil (mg/dl): 17.2 v.s. 6.2, p=0.013, p=0.005, HGF (pg/ml):1879 vs. 1092, p=0.03). The 1-year survival rate was significantly lower in H-I group (50%) than in L-I group (92.9%) (p=0.026).

[Study II] MELD score in H-II group was significantly higher than those in L-II group (21.1 vs. 12.7, p=0.002). The liver regeneration ratio did not differ between two groups (H-II v.s. L-II: 1.01 v.s. 1.04). The 1-, 5-, 10-year survival rate were significantly lower in H-II group than in L-II group (H-II v.s. L-II: 65.0%, 48.5%, 38.6% vs. 86.5%, 80.8%, 73.4%, p=0.004). In multivariate analysis, significant prognostic factors were preoperative HA >/= 500 ng/ml (p=0.004) and graft weight recipient bad weight ratio <0.8 (p=0.042).

Conclusion:

Preoperative HA can be one of important predict markers for recipient outcome.

CITATION INFORMATION: Mizuno S, Das B, Iizawa Y, Kato H, Murata Y, Tanemura A, Kriyama N, Azumi Y, Kishiwada M, Usui M, Sakurai H, Isaji S. Pretransplant Serum Hyaluronic Acid Can Be a Prognostic Predictor in Adult-to-Adult Living Donor Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).

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