Title:Current Strategies to Minimize Ischemia-Reperfusion Injury in Liver
Transplantation: A Systematic Review
Volume: 16
Issue: 4
Author(s): Carlo Gazia, Ilaria Lenci, Tommaso M Manzia, Milana Martina, Giuseppe Tisone, Roberta Angelico, Ludovico Abenavoli, Giuseppe Grassi, Alessandro Signorello and Leonardo Baiocchi*
Affiliation:
- Hepatology and Liver Transplant Unit, University of Tor Vergata, 00133, Rome,Italy
Keywords:
Adult liver transplantation, ischemia-reperfusion injury, immune system, molecular biology, biomarkers, immunosuppression.
Abstract: Background: Hepatic Ischemia Reperfusion Injury (IRI) is a serious threat that characterizes
the liver but also other transplantable organs. The worst effect of long-term IRI on an impaired
graft could lead to irreversible damage and organ failure. Several events characterize the cascade
that ultimately leads to organ failure. Among all, multiple strategies have been attempted to
identify early phenomena of IRI with divergent results, and biomarkers might represent a novel approach
to early detect ischemic damage.
Methods: A literature review of the current state-of-the-art on IRI was conducted in the present
manuscript. Information was collected from worldwide clinical trials conducted in highly specialized
institutions. Experiments conducted on IRI animal models and clinical studies were screened.
The final outcomes were analyzed and reported in the present review.
Results: Matrix Metalloproteinases (MMPs) represent an interesting example of the early detector
of neutrophil invasion after acute and chronic hepatic IRI. Neutrophil Gelatinase-associated Lipocalin
(NGAL) is another biomarker which seems more predictable of the IRI gravity phase. Mitochondrial
flavin mononucleotide (FMN) was recently discovered and might become a reliable biomarker
of hepatic IRI during Hypothermic Oxygenation Machine Perfusion (HOPE).
Conclusion: The available strategies to avoid IRI, despite constantly improving, are still lacking a
gold standard method. Further studies are still needed to explore new options in the IRI diagnosis
and treatment, and to this purpose, regenerative medicine and tissue engineering surely can play a
pivotal role in the transplantation field.
