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Hyaluronate levels in donor organ washout effluents: a simple and predictive parameter of graft viability

Rao, Prakash N and Bronsther, Oscar L and Pinna, Antonio D and Snyder, James T and Cowan, Scott and Sankey, Scott and Kramer, David and Takaya, Shunichi and Starzl, Thomas (1996) Hyaluronate levels in donor organ washout effluents: a simple and predictive parameter of graft viability. Liver, 16 (1). 48 - 54. ISSN 0106-9543

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Abstract

<jats:p><jats:bold>Abstract: </jats:bold> The principal cause of primary non‐function in orthotopic liver transplantation is thought to be preservation injury to the microvasculature. We, therefore, evaluated if effluent levels of hyaluronate, whose uptake is an endothelial cell marker, could predict early graft function and ultimate graft outcome in orthotopic liver transplantation. A total of 102 cases were studied in two phases. In the first phase, we attempted to determine if a correlation existed between effluent hyaluronate levels, early graft function and ultimate graft outcome. This phase of the study was also used to determine hypothetical cut‐off values for hyaluronate which could discriminate between good and bad livers. Thirty‐two livers orthotopically transplanted to randomly selected primary recipients were studied. After varying periods of static cold storage (4°C) in University of Wisconsin solution, the livers were reinfused with cold (4°C) lactated Ringer's solution. The first 50 ml of the reperfusion effluent was collected from the infrahepatic vena cava. Effluent samples were analyzed for hyaluronate. Linear regression analysis demonstrated a significant correlation between effluent hyaluronate levels and post‐operative aspartate and alanine aminotransferase levels (p&gt;0.001 for both). Logistic regression demonstrated a highly significant correlation (p=0.0056) between effluent hyaluronate levels and ultimate graft outcome. Generation of Receiver Characteristics Curves indicated that a level between 400 and 430 μg l<jats:sup>‐1</jats:sup> could possibly discriminate between good livers and those at risk of early graft failure. The authenticity of this hyaluronate cut‐off level was further confirmed in the second phase of the study where 70 consecutive primary crossmatch‐negative transplants were performed. A highly significant difference was observed in peak aspartate and alanine aminotransferase levels in the first week (p&gt;0.0006 and p&gt;0.0005, respectively) between livers with effluent hyaluronate levels 400 μg · l<jats:sup>‐1</jats:sup> and livers with hyaluronate levels higher than 400 μg l<jats:sup>‐1</jats:sup>. Logistic regression revealed a highly significant correlation between effluent hyaluronate levels and graft success (p=0.0001). Since hyaluronate uptake by the microvascular endothelial cell is significantly greater than production, high hyaluronate effluent levels in failed livers would be due to decreased hyaluronate uptake by the injured microvascular endothelial cell. We therefore conclude that effluent hyaluronate levels may prove to be a reliable preoperative test to assess early graft function and outcome in clinical orthotopic liver transplantation.</jats:p>


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Rao, Prakash N
Bronsther, Oscar L
Pinna, Antonio D
Snyder, James T
Cowan, Scott
Sankey, Scott
Kramer, David
Takaya, Shunichi
Starzl, Thomastes11@pitt.eduTES11
Centers: Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute
Date: February 1996
Date Type: Publication
Journal or Publication Title: Liver
Volume: 16
Number: 1
Publisher: Wiley
Page Range: 48 - 54
DOI or Unique Handle: 10.1111/j.1600-0676.1996.tb00703.x
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0106-9543
Other ID: uls-drl:31735062125657, Starzl CV No. 1648
Date Deposited: 08 Apr 2010 17:28
Last Modified: 05 Nov 2023 16:55
URI: http://d-scholarship.pitt.edu/id/eprint/5034

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