The Impact of Ischemia/Reperfusion Injury On Liver Allografts from Deceased After Cardiac Death Versus Deceased After Brain Death Donors
1Liver Transplant Unit, Institute of Liver Studies, King's College Hospital, London, United Kingdom
Department of Transplant Surgery, Emory University, Atlanta, United Kingdom
Institute of Pharmaceutical Science, King's College Hospital, London, United Kingdom
Department of Analytical Chemistry, University of Salamanca, Salamanca, Spain
Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom.
Meeting: 2015 American Transplant Congress
Abstract number: C115
Keywords: Liver transplantation
Session Information
Session Name: Poster Session C: Liver Donation and Allocation
Session Type: Poster Session
Date: Monday, May 4, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Background and Aims:
The shortage of appropriate organs for transplantation has led to the use of organs from donors after cardiac death. The pathophysiologic processes associated with cardiac as compared to brain death are poorly understood. The aim of this study was to determine how the ischemia/reperfusion (I/R) affects allografts obtained from donors after cardiac death (DCD) versus brain death (DBD).
Methods: Leukocyte infiltration and expression of inflammatory and cell death markers were compared between DCD (n=22) and DBD (n=13) livers by immunohistochemical (IHC) analysis using pre- and post-reperfusion liver biopsies. TUNEL staining was performed to evaluate cell death. Hepatocyte inflammation was assessed by liquid chromatography-mass spectrometry (LC-MS) measurement of various ceramides in an independent cohort of DCD (n=13) and DBD (n=10) allografts.
Results: Prior to transplantation, DBD livers have higher levels of leukocyte infiltration and increased expression of FasL and high levels of intracellular adhesion molecule-1 (ICAM-1), as compared to DCD allografts. Following reperfusion, the neutrophil infiltration and platelet deposition associated with I/R injury remained more prominent in DBD grafts as compared to their DCD counterparts. Further, there was greater upregulation of pro-inflammatory ceramides in post-transfusion biopsies in DBD as compared to DCD allografts. Despite decreased inflammation, DCD allografts had significantly higher levels of cell death than DBD grafts, which correlated with the duration of warm ischemia time as well as significantly higher levels of aspartate aminotransferase (AST) in the serum in the acute post-transplant period.
Conclusions: These data suggest that ischemia/reperfusion injury causes a non-inflammatory necrosis in DCD allografts with an appreciable effect on early graft function. The long-term consequences of increased inflammation in DBD allografts and cell death in DCD allografts are unknown and warrant further investigation.
To cite this abstract in AMA style:
Sayed B, Xu J, Casas-Ferreira A, Srinivasan P, Heaton N, Ma Y, Legido-Quigley C, Fuggle S, Jassem W. The Impact of Ischemia/Reperfusion Injury On Liver Allografts from Deceased After Cardiac Death Versus Deceased After Brain Death Donors [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-ischemiareperfusion-injury-on-liver-allografts-from-deceased-after-cardiac-death-versus-deceased-after-brain-death-donors/. Accessed May 17, 2025.« Back to 2015 American Transplant Congress