Immunosuppressive therapy and organ preservation in liver transplantation

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1. Immunosuppressive TherapyIn rats which were given FK506,immuno-histochemical study showed a marked histological change of the endothelial cells. This finding suggests a possibility of toxic side effect of this drug.In the allotransplant models, it is suggested that a short course of FK506 provided a sufficient immunosuppression.2. Liver Graft PreservationThe rat liver preserved in UW solution showed less endothelial injury and less impairment of peripheral vascular perfusion as well as higher tissue nucleotides level than in EuroCollins solution.In the experiment of rat liver perfusion, Carolina rinse solution showed a protective effect against sinusoidal injury caused by reperfusion. In the pig liver transplant models, graft survivals were better in the animals which were treated with Carolina rinse solution than those without it. Postoperative transaminases were lower and graft histology was better in the group rinsed with Carolina solution than that without it.3. Liver Graft ProtectionPreoperative administration of cyclosporine or FK506 provided better blood flow in the liver graft, less transaminasemia and less production of free radicals than the grafts which were not given the drugs preoperatively. It is demonstrated that these drugs can minimize reperfusion injury.It was shown that liver glutathione level lowered during preservation. However, this was prevented by the administration of glutathione precursors.Administration of thromboxane A2 synthetase inhibitors to the donor animals lnduced improvement of graft circulation after transplantation.Above findings confirms that donor and recipient management is of prime importance in the liver transplantation.Key Words: liver transplantation, preservation, reperfusion injury, oxygen free radial, FK506, thromboxane B2, thromboxane A2, endotherial cell