Prospective study comparing steatotics vs non steatotics grafts in liver transplant - The role of ischemia/reperfusion injury

Abstract

Introduction: Many factors are responsible for the ischemic/reperfusion injury in liver transplants, such as apoptosis. However, the role of ischemic/reperfusion injury in steatotic grafts is still unclear. Purpose: to analyze the role of ischemic/reperfusion injury in liver transplant comparing steatotic vs non-steatotic graft. Patients and Methods: Between May/02 and march/07, 84 liver biopsies (2hours) were performed after arterial reperfusion of grafts. It was performed an amount of 84 liver transplants in 82 patients. Liver biopsies were divided in 5 groups, according to the degree of macro and microvesicular steatosis in: mild (<30%)-MSG, moderate (30-59%)-MoSG, severe (≥60%) – SSG, and absent stetatosis – ASG before reperfusion – BRG. 102 liver biopsies analyzed: the percentage of macro and micro steatosis, neutrophils infiltration degree, apoptosis index (TUNEL and Caspase-3) and ICAM-1. Also, it was analyzed the macro and micro steatosis alone, which were ranked in different degrees: mild (G1), moderate (G2), severe (G3) and absent (G4). Results: The apoptosis index (TUNEL) was: MSG=0.262±0.111, MoSG=0.278±0.113, SSG=0.244±0.117, ASG=0,275±0.094 e BPR=0.181±0.123, p-0.07. The macrosteatosis’ apoptosis index (TUNEL) was G1=0.284± 0.106, G2+3=0.160±0.109, G4=0,275±0.094, p-0.05; and the microsteatosis group - G1=0.222±0.123, G2+3=0.293±0.108, G4=0.275±0.094, p-0.049. There was no statistic difference between groups when analyzing the apoptosis (caspase-3) and ICAM-1 index. Conclusion: The severe steatotic and macrosteatosis groups (degree moderate and severe) presented a significant decrease in the apoptosis index, probably because those cells died before starting the apoptotic process. However, the microsteatosis group (degree moderate and severe) increased the apoptotic index associated to the ischemic/reperfusion injury.