Effects of ischemic preconditioning in a pig model of large-for-size liver transplantation

Author(s)

Goncalves Leal, Antonio Jose ^{[1, 2]} ; Aoun Tannuri, Ana Cristina ^{[1, 2, 3]} ; Belon, Alessandro Rodrigo ^[3] ; Nunes Guimaraes, Raimundo Renato ^{[1, 2]} ; Mendonca Coelho, Maria Cecilia ^{[1, 2]} ; Goncalves, Josiane de Oliveira ^{[1, 2]} ; Serafini, Suellen ^{[1, 2]} ; de Melo, Evandro Sobroza ^[4] ; Tannuri, Uenis ^{[1, 2]}

Affiliation

^[1] Univ Sao Paulo, Fac Med, Div Pediat Surg, Pediat Liver Transplantat Unit, Sao Paulo, SP - Brazil

^[2] Univ Sao Paulo, Fac Med, Div Pediat Surg, Lab Res Pediat Surg LIM 30, Sao Paulo, SP - Brazil

^[3] Univ Sao Paulo, Fac Med, Dept Surg Tech & Expt Surg, Sao Paulo, SP - Brazil

^[4] Univ Sao Paulo, Fac Med, Liver Funct Res Lab LIM 14, Sao Paulo, SP - Brazil

• Document type: Journal article
• Source: Clinics; v. 70, n. 2, p. 126-135, 2015.
• Web of Science Citations: 8

Abstract

OBJECTIVE: In most cases of pediatric liver transplantation, the clinical scenario of large-for-size transplants can lead to hepatic dysfunction and a decreased blood supply to the liver graft. The objective of the present experimental investigation was to evaluate the effects of ischemic preconditioning on this clinical entity. METHODS: Eighteen pigs were divided into three groups and underwent liver transplantation: a control group, in which the weights of the donors were similar to those of the recipients, a large-for-size group, and a large-for-size + ischemic preconditioning group. Blood samples were collected from the recipients to evaluate the pH and the sodium, potassium, aspartate aminotransferase and alanine aminotransferase levels. In addition, hepatic tissue was sampled from the recipients for histological evaluation, immunohistochemical analyses to detect hepatocyte apoptosis and proliferation and molecular analyses to evaluate the gene expression of Bax (pro-apoptotic), Bcl-XL (anti-apoptotic), c-Fos and c-Jun (immediate-early genes), ischemia-reperfusion-related inflammatory cytokines (IL-1, TNF-alpha and IL-6, which is also a stimulator of hepatocyte regeneration), intracellular adhesion molecule, endothelial nitric oxide synthase (a mediator of the protective effect of ischemic preconditioning) and TGF-beta (a pro-fibrogenic cytokine). RESULTS: All animals developed acidosis. At 1 hour and 3 hours after reperfusion, the animals in the large-for-size and large-for-size + ischemic preconditioning groups had decreased serum levels of Na and increased serum levels of K and aspartate aminotransferase compared with the control group. The molecular analysis revealed higher expression of the Bax, TNF-alpha, I-CAM and TGF-beta genes in the large-for-size group compared with the control and large-for-size + ischemic preconditioning groups. Ischemic preconditioning was responsible for an increase in c-Fos, IL-1, IL-6 and e-NOS gene expression. CONCLUSION: Ischemia-reperfusion injury in this model of large-for-size liver transplantation could be partially attenuated by ischemic preconditioning. (AU)

• FAPESP's process: 11/12550-0 - Experimental model of liver transplantation large-for-size in growing animals: morphometric, histological and molecular studies
• Grantee: Uenis Tannuri
• Support Opportunities: Regular Research Grants