Comments on: Hyperacute rejection in liver transplantation?

By: boston plastic surgeon

boston plastic surgeon — Tue, 22 Mar 2011 12:31:14 +0000

This is really a great story.The liver is not as antigenic as other solid organs, assessment for rejection of the transplanted liver is a major focus of patient care. The liver has immune characteristics (ie, Kupffer cells, vascular and sinusoidal endothelial cells, and portal dendritic and inflammatory cells) that logically should promote graft rejection.

By: Joe

Joe — Fri, 21 May 2010 11:06:22 +0000

Thanks for sharing this case.

By: I. Mitsiev

I. Mitsiev — Sun, 09 May 2010 22:16:01 +0000

Thank you for you comment and the very reasonable question, Amit!
The cold ischemia time (CIT) plays a significant role in the delayed graft function (DGF) in kidney transplantation. 11.5 hours shouldn’t be the time a liver dies completely when appropriately preserved, like in this case.
In a good meta-analysis about the role of CIT in primary non-function (PNF) of liver allografts by a mixed (MGH and Pittsburgh) group (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430537/?tool=pubmed) from about 2 years ago, the authors show that there is not a linear dependency between the CIT and the PNF. Furthermore, the graft survival was excellent in the CIT-group of 10–12.5 hrs.

There is no doubt that a prolonged CIT does not help. But I just don’t believe that the role of the CIT in the PFN of this liver was crucial. The liver was also not really fatty. Much fattier livers have been transplanted without any significant problems.

The common sense would tell that a prolonged CIT would result in DGF prior to a PNF. But there was no DGF here!
There must have been something else that killed the liver in this case, Amit… but I don’t know what.

By: Amit Jain

Amit Jain — Sun, 09 May 2010 20:02:35 +0000

Thanks a lot for sharing this case. What are your thoughts on – if the cold ischemia time of 11.5 hr had to play a part in the primary non function of this fatty liver ?