Chemokines: reliable markers for diagnosis of rejection and inflammation following orthotopic liver transplantation.

Destruction of Kupffer’s cells increases total liver blood flow and decreases ischemia reperfusion injury in pigs

Influence of N-acetylcysteine on hepatic amino acid metabolism in patients undergoing orthotopic liver transplantation

Experimental treatment with the antioxidant and glutathione precursor N-acetylcysteine (NAC) has been performed in orthotopic liver transplantation (OLT) to reduce reperfusion injury. To investigate the effect of NAC on the hepatic and intestinal amino acid metabolism, intraoperative amino acid exchange rates were studied in liver transplant recipients with high dose NAC treatment (n = 10) and in control patients (n = 9). Treatment with NAC was found to cause a loss of amino acids and increased urea nitrogen release from the liver graft. The net balance of most amino acids was shifted to increased hepatic release or decreased hepatic uptake. The initial cumulative splanchnic release of all …

Effektiver Schutz vor Ischemic Type Biliary Lesions nach orthotoper Lebertransplantation durch arterielle ex situ-Nachperfusion unter Druck

Einleitung: Ischemic Type Biliary Lesions (ITBL) sind eine gefurchtete Komplikation nach Lebertransplantation, welche zum einem die Lebensqualitat des Patienten stark einschrankt und zum anderen mit erheblicher Mortalitat verbunden ist. In der Literatur werden verschiedene Faktoren, wie z. B. lange kalte Ischamiezeit, Alter des Organspenders und der Einsatz von University of Wisconsin (UW)-Losung als ursachlich angeschuldigt. Die hochviskose UW-Losung erreicht moglicherweise nicht die kleinen Arteriolen der Gallenwege und fuhrt dadurch zu einer mangelhaften Konservierung der Gallenwege. Im folgenden berichten wir uber die Moglichkeit der arteriellen Nachperfusion unter Druck nach der Explan…

Differenzielle Expression von CC-Chemokinen nach orthotoper Lebertransplantation während Rejektion und Infektion

Einleitung: Chemokine sind niedermolekulare Zytokine, die fur die Geweberekrutierung inflammatorischer Leukozyten verantwortlich sind. Eine Leukozyteninfiltration ist charakteristisch fur die akute Transplantatabstosung nach Lebertransplantation. Wir vermuten, dass die hepatische Chemokinsekretion als Vermittler von Abstosungsreaktionen nach Lebertransplantation eine Rolle spielen konnte. Daten zum Chemokinverlauf nach Lebertransplantation im peripheren Blut liegen bislang nicht vor. Material und Methoden: In dieser Untersuchung wurden die Serumchemokinkonzentrationen fur die CC-Chemokine CCL2 (Monocyte chemoattractant protein 1, MCP-1), CCL3 (Macrophage inflammatory protein I alpha, MIP-1γ…

Prevention of ischemic-type biliary lesions by arterial back-table pressure perfusion

Abstract Ischemic-type biliary lesions (ITBLs) lead to considerable morbidity after orthotopic liver transplantation (OLT). The exact pathogenesis is unknown. We tested the hypothesis that insufficient perfusion of biliary arterial vessels might be responsible for ITBLs. This could be prevented by improved perfusion techniques. Since February 2000, we performed a controlled study using arterial back-table pressure perfusion (AP) to achieve reliable perfusion of the biliary-tract capillary system, which may be impaired by the high viscosity of University of Wisconsin solution. We retrospectively analyzed 190 OLTs performed between September 1997 and July 2002 with regard to ITBLs. One hundre…

The efficacy of N-acetylcysteine as a hepatoprotective agent in liver transplantation

One of the most common complications after liver transplantation is primary graft dysfunction which results from severe deterioration of the microcirculation. The data obtained from our experimental studies indicate that N-acetylcysteine (NAC) is able to reduce the severity of ischemia/reperfusion injury and improves postoperative graft function after liver transplantation in rats. The aim of this pilot study was to evaluate the efficacy of NAC as a hepatoprotective agent under clinical conditions. A group of 30 liver transplanted patients were treated with NAC, and 30 patients (control group) were treated with a 5 % solution of glucose only. In the NAC group we observed a distinct reductio…

Differential diagnosis of cytomegalovirus infection and acute rejection by serum CC-Chemokine measurement after orthotopic liver transplantation