ELSEVIER Value of Caval Effluent in Predicting Early Graft Function After Orthotopic Liver Transplantation T. Suehiro, P. Boros, S. Emre, P. Sheiner, S. Guy, M. Schwartz, and C.M. Miller T HE POSSIBLE roles of different markers measured in the caval effluent for predicting graft function after OLTX have been evaluated in both clinical and experimental settings by several groups.1-4 We measured perioperative levels of eight markers that might have a role in the development of preservation/reperfusion in- jury and correlated their levels with early graft perfor- mance. A set of cytokines (interleukin [IL]-1 beta, IL-8, hepatocyte growth factor [HGF], vascular endothelial growth factor [VEGF], and granulocyte colony stimulat- ing factor [GCSF]), prostaglandins such as thromboxane B2 [TXB2], and endothelial cell markers including hyal- uranic acid [HA], and thrombomodulin [TM] were eval- uated. PATIENTS AND METHODS Blood samples were collected from 29 adult primary liver trans- plant recipients at the following time points: before surgery, just before reperfusion from the portal vein, and from the first and last 20 mL of caval effluent. All measurements were based on different types of ELISA methods; cytokine assays were obtained from R&D Systems, MN, the HA assay from REAADS Medical Products, Co. The TM kit was obtained from Fuji Chemical Industries Ltd. Japan, and the TXB2 ELISA from Amersham, Ill. HA uptake was defined as the ratio of the actual measurement and the value obtained from the portal vein sample. Poor early graft function (PEGF) was defined as peak AST or ALT >2500 U/L for the first three postoperative days (POD) and prothrombin time >16 sec- onds on POD 2. RESULTS Levels of TM, HGF, and IL-1 in the first effluent sample were significantly higher than those measured just before reperfusion. Furthermore, eftluent IL-l, IL-8, TM and HGF levels showed a positive linear correlation to cold ischemic time (P < .05 for all measurements). Patients with PEGF had significantly higher IL-l. IL-8, TM, HGF, VEGF, and GCSF levels and HA uptake ratio than those with good early graft function (GEGF) (Table 1). DISCUSSION Preservationireperfusion injury is considered an impor- tant factor in the development of poor early graft function. The possible mediators of this damage include a wide variety of factors such as reactive oxygen metabolites, cytokines, phospholipase A,. eicosanoids, proteases, nitric oxide and endothelin. Factors like TM and HA which derive from or are metabolized by endothelial cells reflect the integrity of sinusoidal lining. The increased level of TM, HGF, and IL-l in the first effluent sample suggest that the From the Department of Surgery, Division of Abdominal Organ Transplantation, Mount Sinai School of Medicine, New York, NY. Address reprint requests to Dr P. Boros, Division of Abdominal Organ Transplantation, The Mount Sinai School of Medicine, POB 1504, One Gustave L. Levy Plau, New York, NY 10029. Table 1. Effluent Data According to Early Graft Function IL-1 IL-8 HGF VEGF GCSF TM TX82 HA Uptake GEGF (n = 21) 24 i 36 190 2 368 9.2 2 4.8 99 z 127 169 2 359 9.5 k 8.8 6.8 r+_ 3.9 0.62 -t 0.27 PEGF (n = 8) 125 + 105 755 2 933 19.1 i- 9.4 475 * 374 1208 5 2171 39.3 2 27.8 17.4 + 7.2 0.84 ? 0.18 P value .0008 .0491 .0029 .0005 .0383 .OOOl .0004 .0139 0 1997 by Elsevier Science inc. 655 Avenue of the Americas, New York, NY 10010 0041-1345/97/$17.00 PII SO041 -1345(96)00207-2 469 Transplantation Proceedings, 29, 469-470 (1997)