Effect of remote ischemic preconditioning among donors and recipients following pediatric liver transplantation:A randomized clinical trial

BACKGROUND Studies suggested that remote ischemic preconditioning(RIPC)may effectively lessen the harmful effects of ischemia reperfusion injury during organ transplantation surgery.AIM To investigate the protective effects of RIPC on living liver donors and recipients following pediatric liver transplantation.METHODS From January 2016 to January 2019 at Renji Hospital Affiliated with Shanghai Jiao Tong University School of Medicine,208 donors were recruited and randomly assigned to four groups:S-RIPC group(no intervention;n=55),D-RIPC group(donors received RIPC;n=51),R-RIPC group(recipients received RIPC,n=51)and DR-RIPC group(both donors and recipients received RIPC;n=51).We primarily evaluated postoperative liver function among donors and recipients and incidences of early allograft dysfunction,primary nonfunction and postoperative complications among recipients.RESULTS RIPC did not significantly improve alanine transaminase and aspartate aminotransferase levels among donors and recipients or decrease the incidences of early allograft dysfunction,primary nonfunction,and postoperative complications among recipients.Limited protective effects were observed,including a lower creatinine level in the D-RIPC group than in the S-RIPC group on postoperative day 0(P<0.05).However,no significant improvements were found in donors who received RIPC.Furthermore,RIPC had no effects on the overall survival of recipients.CONCLUSION The protective effects of RIPC were limited for recipients who received living liver transplantation,and no significant improvement of the prognosis was observed in recipients.

Expression of programmed death-1 and its ligands in the liver of biliary atresia

Background:An aberrant immune response is the predominant pathogenetic factor in biliary atresia (BA).Programmed death-1 (PD-1) and its two ligands,programmed death ligand-1 and programmed death ligand-2 (PD-L1 and PD-L2,respectively) play an important inhibitory role in immune reactions.We aimed to illustrate the expression of these molecules in BA.Methods:Liver specimens were obtained from infants with BA during the Kasai procedure (early BA) and fiver transplantation (late BA).Intrahepatic expression of PD-1,PD-L1,and PD-L2 were examined by immunostaining and compared with that in patients with neonatal hepatitis syndrome and normal controls.The correlation between the expression levels of these molecules in the liver and clinicopathological parameters was analyzed for each group.Results:Enhanced expression of PD-1 and its ligands occurred in the livers with early BA.In the BA-affected livers,PD-1 was correlated with the degree of peri-bifiary inflammation,while PD-L2 was linked more directly with portal fibrosis.None of the three molecules was correlated with the prognosis of the Kasai procedure in patients with early BA.Conclusion:Only PD-1 and PD-L1 are involved in the immune reactions of early BA.Elucidation of the detailed role of PD-L2 in BA requires further research.