Improving Survival For Small-For-Size Liver Grafts

描述（由申请人提供）：

DESCRIPTION (provided by applicant): Use of partial liver grafting techniques has increased rapidly in recent years; however, small-for-size grafts remain a major problem since many fail when used as donor organs. Therefore, the relationship between graft size and graft failure needs to be understood. The goals of this project are to elucidate mechanisms involved in the failure of small-for-size grafts and to develop strategies to prevent it. We will use reduced-size liver transplantation of decreasing graft weight/standard liver weight (GW/SLW) in rats to test the unique hypothesis that free radicals increase in small-for-size grafts leading to graft failure. Our goal in Aim 1 will be to investigate the effects of graft volume, manipulation during harvest, and cold storage on survival of partial liver grafts. The time course of survival, transaminase release, and liver function will be observed in vivo after transplantation. Liver function will also be evaluated in isolated-perfusion of grafts after transplantation. ATP/ADP/AMP contents and oxygen uptake will be determined to evaluate mitochondrial function. Survival and non-survival conditions will be established, validating it as a useful model for mechanistic studies. Next, we will test the hypothesis that free radicals are produced in small-for-size grafts leading to injury. Effects of graft volume, cold storage, and manipulation during harvest on free radical production, 4-hydroxynonenal, and GSH after transplantation of partial grafts will be determined in Aim 2. We expect free radical production will be increased to a greater extent in small-for-size liver grafts, and cold storage and manipulation will further enhance this effect. In addition, we will identify cellular sources of free radicals using fluorescent probes and intravital multiphoton microscopy. In Aim 3, the effects of antioxidant therapies (polyphenols, Carolina Rinse solution, and gene delivery of superoxide dismutase) on survival of small-for-size grafts will be evaluated under non-survival conditions determined in Aim 1, and effects on transaminase, liver function and free radical production will be compared. We expect that antioxidant therapies will prevent free radical production and reduce graft failure of small-for-size grafts and to identify the most effective therapy. Finally, the effects of antioxidant therapies on liver regeneration will be evaluated in Aim 4. Incorporation of 5-bromo-2'-deoxyuridine and factors regulating regeneration (cytokines, transcription factors, growth factors, and energy supply) will be evaluated. Taken together, we expect that these studies will provide unequivocal evidence supporting a role for free radicals in primary graft failure of small-for-size grafts. This work will develop mechanism-based strategies to increase the use and improve the outcome of partial livers for transplantation in the clinic.