非转流经典原位肝移植病人术中血糖和乳酸的变化

目的 探讨非转流经典原位肝移植病人术中血糖和乳酸的变化。方法 静吸复合全麻下行非转流经典原位肝移植病人80例,男66例,女14例,年龄12～67岁,体重40～130kg,于麻醉前、无肝前期、无肝期30和60min、门静脉开放后5和30min以及手术结束时采集动脉血,测定血糖及乳酸浓度。其中70例采集门静脉开放后的肝静脉血测定。结果 术中无一例出现低血糖,门静脉阻断前血糖轻度上升,无肝期血糖有所回降,但仍高于术前。静脉开放5min时,血糖由开放前6.34mmol/L升高到12.14mmol/L(P<0.01)。术中血乳酸呈进行性上升,术前1.87mmol/L,静脉开放5min时达5.23mmol/L(P<0.01),随后继续维持在高水平。开放门静脉后的肝静脉血血糖达16.0～90.5mmol/L,乳酸9.6～80mmol/L。结论 非转流原位肝移植术中常出现高血糖和高乳酸血症,尤其是移植肝开放循环后,需随时监测并纠正。     

Microsurgical hepatic artery reconstruction during living-donor liver transplantation by using head-mounted surgical binocular system

We have described our experience with arterial reconstruction during living-donor liver transplantation by using Varioscope AF3--a head-mounted surgical binocular system with automatic focusing and continuous zoom magnification from 3.6x to 7.2x. From July 1996 to December 2006, 91 grafts were implanted in 89 living-donor liver transplantation recipients, including two that required retransplantation. For microsurgical reconstruction of the graft hepatic artery, a conventional operating microscope was used in the first 10 transplants and Varioscope, in the subsequent 81. The time required to complete arterial reconstruction while using a conventional operating microscope and Varioscope was 78.6 +/- 44.6 min and 35.5 +/- 15.5 min, respectively. No arterial complications, including hepatic artery thrombosis, occurred in any of the 89 patients during the observation period. In living-donor liver transplantation, successful hepatic artery reconstruction can be safely carried out using Varioscope.     

24‐h storage of pig livers in UW,HTK, hydroxyethyl starch,and saline solution: is microdialysis an appropriate method for the continuous graft monitoring during preservation?

Recent studies demonstrate the feasibility of microdialysis to monitor metabolism in ischemic livers. Whether these parameters correlate with markers of liver cell integrity in an experimental model using pig livers and different preservation solutions was an aim of this study. Pig livers were flushed with either 4 degrees C Histidine-Typtophan-Ketoglutarate solution (HTK) (Custodiol), University of Wisconsin solution (ViaSpan), and hydroxyethyl starch, or 12 degrees C saline solution. After 24-h storage, the livers were rinsed with saline to measure liver enzymes and lactate from the effluate. Utilizing microdialysis, intraparenchymal lactate, pyruvate, glucose, and glycerol was monitored. Tissue biopsies were taken for histological examinations. Cold preservation resulted in a decrease of metabolic activity measured by intrahepatic glucose, lactate, and pyruvate levels, as well as lactate in the effluate, independently of the solution used. Of particular interest, glycerol levels partially reflected the extent of hepatocellular damage and liver enzyme release. Glycerol levels partially discriminated preservation of different quality and were in accordance to histological findings and liver enzyme release. Lactate, pyruvate, and glucose levels were not appropriate as markers during cold storage. Whether or not glycerol monitoring could represent an additional and rational complementation to the current practice of macroscopic, microscopic and donor evaluation has to be clarified by further studies.     

Evidence for segmental bile drainage by hepatic portoenterostomy for biliary atresia: Cholangiographic, hepatic venographic, and histologic evaluation of the liver taken at liver transplantation

Background

The result of hepatic portoenterostomy for biliary atresia (BA) has improved, but there are some patients who experience worsened liver function in the long term after one decrease in jaundice owing to portoenterostomy. However, the cause of the liver dysfunction in the long term has not been clearly ascertained.

Methods

Five patients (5 to 28 years of age) with BA underwent liver transplantation (LT) because of liver dysfunction after successful portoenterostomy. To clarify the cause of liver dysfunction occurring in the long term, the authors performed a cholangiogram, hepatic venogram, and macroscopic/microscopic examination of the liver just after LT.

Results

(1) Macroscopically, the liver could be divided into 3 areas, the hypertrophic, atrophic, and intermediate, with findings between those of the hypertrophic and atrophic areas. (2) The divided areas clearly corresponded to the liver segments. Segment IV was the hypertrophic area in all patients, but segments VI and VII were the atrophic areas in 4 of the 5 patients. (3) Based on the cholangiographic and microscopic findings, the hypertrophic area had near-normal structure with bile ducts. The atrophic area had severe fibrosis and contained only a few bile ducts in the intralobular spaces of liver.

Conclusions

It seems that segmental bile drainage must have been established by hepatic portoenterostomy in some patients and that some postoperative patients might have worsened liver function in the long-term follow-up period accompanied with progression of fibrosis and impaired bile drainage. These pathologic changes occur in each liver segment.     

Peri-operative liver graft function: monitoring using the relationship between blood glucose and oxygen consumption during anaesthesia

The purpose of our study was to test the hypothesis that the quotient between plasma glucose and whole body oxygen consumption (VO2) as a 'metabolic index' is a sensitive indicator of early graft function. Arterial levels of glucose and oxygen consumption were determined in 100 consecutive patients during orthotopic liver transplantation performed without anhepatic veno-venous bypass. Patients were divided into survivors with no obvious problems related to graft function and those with primary nonfunction of the graft. The neohepatic increase in VO2 was significantly higher in survivors (112 +/- 4 vs 88 +/- 11 ml.min-1.m-2; p < 0.05), whereas blood glucose levels after reperfusion were higher (352 +/- 18 vs. 287 +/- 36 mg dl-1) in those with primary non-function of the graft. The calculated metabolic index was also higher (4.02 +/- 0.93 vs 2.67 +/- 0.45, p < 0.05) in patients with primary nonfunction of the graft. Our principal conclusion was that 92% of normal functioning liver grafts could be classified correctly by the metabolic index immediately after reperfusion, whereas glucose levels and VO2 alone classified only 67% and 70% of normal functioning liver grafts correctly.     

Experimental study on renal and hepatic glucose metabolism in total gastrectomized dogs with special reference to glycolysis and gluconeogenesis

In spite of the extensive studies on glucose metabolism in surgical field, the postoperative renal and hepatic glucose metabolism and their interrelation have not been reported. The present study was undertaken to interrelate the metabolic states in the kidney and the liver in total gastrectomized dogs. In the kidney, the glycolysis was inhibited in the early postoperative stage whereas the gluconeogenesis was activated. In the late postoperative stage the glycolysis remained slightly inhibited, while the gluconeogenesis remained activated. In the liver, in the early postoperative stage the glycolysis was inhibited, whereas the gluconeogenesis was activated. The glycolysis in the late postoperative stage returned to the preoperative stage, while the gluconeogenesis remained inhibited. The gluconeogenesis in both kidney and liver was disturbed in the early postoperative stage while they were restored, but were reversed, in the late postoperative stage.     

扫描式葡萄糖监测系统在肝移植术后早期受者中的应用研究

目的探讨扫描式葡萄糖监测(FGM)系统在肝移植术后早期受者中的应用。 方法选取2019年4月至8月在中山大学附属第一医院器官移植中心行同种异体肝移植术的28例受者,应用FGM系统(美国雅培公司)连续监测组织间液葡萄糖浓度。同时采集受者清晨空腹血液标本,使用全自动生化分析仪检测静脉血糖值作为参考,评估FGM血糖值临床应用的精准性。使用R语言3.6.1软件进行克拉克误差网格分析。采用配对t检验或秩和检验比较术后第1周与第2周FGM结果,采用Pearson相关分析比较FGM血糖值与静脉血糖值的相关性。计算FGM血糖值与静脉血糖值配对数据的平均相对误差绝对值(MARD)和决定系数r²,比较两种血糖检测方法的一致性。P<0.05为差异有统计学意义。 结果28例受者平均佩戴FGM系统时间为(12.5±2.4)d(7～14 d),佩戴期间均未出现过敏、瘙痒、皮肤红斑、青紫和疼痛等不良反应,均未出现传感器脱落。FGM系统佩戴期间,28例受者预估糖化血红蛋白为(6.7±1.7)%,FGM血糖值为(8±3)mmol/L,目标范围内时间为(72±34)%,低于和高于目标范围时间中位数分别为1%和8%。3例受者FGM血糖值全程在目标范围内,23例出现过高于目标范围,14例出现过低于目标范围。肝移植术后第2周FGM血糖值低于术后第1周,分别为(8±3)、(9±4)mmol/L,差异有统计学意义(t＝2.4,P<0.05);术后第2周低于目标范围时间中位数(1%)高于术后第1周(0%),差异有统计学意义(z＝-2.5,P<0.05)。FGM系统佩戴期间共采集244对空腹FGM血糖值与静脉血糖值,平均血糖值分别为(7±4)、(8±4)mmol/L,二者呈高度正相关(r＝0.976,P<0.05)。以全自动生化分析仪检测的静脉血糖值作为参考,克拉克误差网格分析结果示：FGM血糖值有93%(227/244)落在A区,有7%(17/244)落在B区。MARD＝9.8%,r²＝0.95。 结论FGM系统在肝移植术后早期受者中的临床应用是可行的,与常规间断末梢血糖监测方法相比,可监测到更多血糖异常事件及其持续时间,并及时采取有效治疗措施,控制血糖水平在最佳范围。     

Extrahepatic arteries of the human liver – anatomical variants and surgical relevancies

The purpose of our study was to investigate the anatomical variations of the extrahepatic arterial structures of the liver with particular attention to rare variations and their potential impact on liver surgery. A total of 50 human abdominal organ complexes were used to prepare corrosion casts. A multicomponent resin mixture was injected into the abdominal aorta. The portal vein was injected with a different colored resin in 16 cases. Digestion of soft tissues was achieved using cc. KOH solution at 60–65 °C. Extrahepatic arterial variations were classified according to Michels. All specimens underwent 3D volumetric CT reconstruction. Normal anatomy was seen in 42% of cases, and variants were seen in the other 58%. No Michels type VI or X variations were present; however, in 18% of cases the extrahepatic arterial anatomy did not fit into Michels' classification. We report four new extrahepatic arterial variations. In contrast to the available data, normal anatomy was found much less frequently, whereas the prevalence of unclassified arterial variations was higher. We detected four previously unknown variations. Our data may contribute to the reduction of complications during surgical and radiological interventions in the upper abdomen.     

肝癌肝移植疗效评价及预后多因素分析

目的 评价肝移植治疗原发性肝癌的疗效,并分析影响预后的因素。方法 回顾性分析2001年12月至2006年12月第二军医大学附属长征医院肝移植科234例肝癌肝移植病人的临床资料。用SPSS11.0软件进行统计分析,用Kaplan-Meier法计算累计和无瘤存活率,Log-rank检验和Cox回归模型分别进行预后单、多因素分析。结果 全组随访1～56个月,随访期间死亡85例(36.3%),复发70例 (29.9%)。术后6个月及1、2、3、4年累计存活率分别为88.5%及76.3%、61.3%、53.6%、47.6%;6个月及1、2、3年无瘤存活率分别为80.1%及70.6%、60.4%、52.3%。单因素分析显示：术前肝功能Child-Pugh分级、术前甲胎蛋白（AFP）水平、肿瘤类型、肿瘤大小、淋巴结转移、大血管侵犯、肿瘤分化程度和TNM分期与预后有关;Cox回归多因素分析显示：术前AFP水平、肿瘤类型、大血管侵犯和肿瘤分化程度是影响预后的独立因素。结论 肝移植是治疗原发性肝癌的有效方法,经严格筛选的适宜受体预后良好。     

Remnant liver regeneration and spleen volume changes after living liver donation: influence of the middle hepatic vein

BACKGROUND AND OBJECTIVES: Graft harvest with or without the middle hepatic vein (MHV) affects venous return and function of the remaining liver. The aims of this study are to compare the remnant liver volume and spleen changes in the donors of different types of graft harvest and to evaluate the influence of resection with or without the MHV on the remnant liver volume regeneration, spleen volume change and serum total bilirubin. PATIENTS AND METHODS: A total of 165 donors were grouped according to the type of graft harvest: 88 donors underwent left lateral segmentectomy (LLS), 10 donors underwent extend LLS or left lobectomy (LL), and 67 donors underwent right lobectomy (RL). Groups LLS and LL were later combined as group LH (left hepatectomy, n = 98). There were 68 men and 97 women. The mean age was 32.9 +/- 8.1 yr. The total liver volume (LV) and spleen volume (S1) before graft harvest, graft weight (GW), regenerated liver volume (LV(6m)) and spleen volume (S2) six months post-donation were calculated. RESULTS: There were no significant differences in the regenerated liver volume six months postoperation (LV(6m)) and recovery ratio (LV(6m)/LV x 100%) among the different groups, albeit significant smaller LV(6m) in both groups compared with the initial liver volume was noted. Postoperative spleen volume (S2), average spleen ratio (S2/S1) and spleen change ratio were significantly larger and higher in group RL than in group LH. A significant increase in spleen volume was noted in both groups six months after graft harvest. A significantly higher TB in group RL (4.1 +/- 1.7 mg/dL, range: 1.4-8.5 mg/dL) was noted compared with that of group LH (1.6 +/- 1.0 mg/dL, range: 0.7-6.2 mg/dL). CONCLUSION: There was a significant increase in the regenerated remnant liver and splenic volumes six months postoperation in all types of hepatectomy following living donor hepatectomy, and there was no difference in the mean TB levels among donors whether the MHV was included or not in the graft.     

Monitoring extracellular concentrations of lactate,glutamate, and glycerol by in vivo microdialysis in the brain during liver transplantation in acute liver failure

Swelling of cerebral glial cells is a characteristic complication in patients with acute liver failure (ALF). This astrocyte edema may result in high intracranial pressure (ICP) and brain herniation before or during liver transplantation. Metabolic alterations responsible for the development of high ICP in patients with ALF are not fully understood. We describe changes in neurochemistry during liver transplantation using a cerebral microdialysis technique in a young man with severe ALF and cerebral edema. We found that the extracellular content of lactate ([lactate]_ec) gradually increased during the operation. Becauce cerebral oxygen saturation and [lactate]_ec to [pyruvate]_ec ratio were within normal limits, hypoxia was not likely to be responsible for the increased [lactate]_ec levels. Instead, we found that [lactate]_ec levels correlated in this patient with arterial lactate concentrations during and after grafting (r² = 0.96; P [lt ] .05), but did not correlate with arterial glucose concentrations (r² = 0.20; P = not significant). Also, [glutamate]_ec and [glycerol]_ec levels were severely elevated before liver transplantation, but tended to decrease in the hours after grafting. These findings indicate disturbances in glutamate neurotransmission, arachidonic acid metabolism, and lactate flux across the blood-brain barrier in patients with ALF. (Liver Transpl 2002;8:302-305.)     

Plasma amino acids in cirrhosis and after liver transplantation: influence of liver function, hepatic hemodynamics and circulating hormones

Liver cirrhosis is characterized by substantial changes in amino acid (AA) metabolism, resulting in a deranged plasma AA profile. To investigate the effect of liver transplantation (OLT), we studied arterial AA profiles in 52 patients with advanced cirrhosis, 16 stable patients over 6 months after OLT and 48 controls. Changes in AA levels were correlated with portal pressure (hepatic venous pressure gradient), functional hepatic blood flow (indocyanine green extraction) and circulating hormone levels (catecholamines, insulin, C-peptide). Fourteen of 18 measured AA were significantly altered in cirrhosis and 11 of 18 remained abnormal after OLT compared with controls. Aromatic AA (AAA) and methionine were elevated in cirrhosis (p < 0.001 each), increasing with disease stage, and normalized after OLT. Branched chain AA (BCAA) levels were decreased in cirrhosis (p < 0.001) and were unrelated to disease stage. After OLT, BCAA levels remained subnormal (p < 0.01), although higher than in cirrhosis (p < 0.001). AAA levels increased with decreasing functional hepatic blood flow (r = -0.67; p < 0.001) and increasing portal pressure (r = 0.59; p < 0.001). BCAA levels decreased with increasing catecholamine (r = - 0.54, p < 0.001) and insulin levels (r = - 0.40, p = 0.001). We conclude that despite normal liver function, AA metabolism is only partially normalized after OLT. AAA levels mainly determined by hepatic metabolic function and functional liver blood flow return to normal, while BCAA levels remain subnormal, indicating persistent changes in muscular AA metabolism after OLT.     

Donor morbidity in right and left hemiliver living donor liver transplantation: the impact of graft selection and surgical innovation on donor safety

This study investigated adequate liver graft selection for donor safety by comparing postoperative donor liver function and morbidity between the right and left hemilivers (RL and LL, respectively) of living donors. Between April 2006 and March 2012, RL (n = 168) and LL (n = 140) donor operations were performed for liver transplantation at Kyoto University Hospital. Postoperative hyperbilirubinemia and coagulopathy persisted in RL donors, whereas the liver function of LL donors normalized more rapidly. The overall complication rate of the RL donors was significantly higher than that of the LL donors (59.5% vs. 30.7%; P < 0.001). There were no significant differences in severe complications worse than Clavien grade IIIa or in biliary complication rates between the two donor groups. In April 2006, we introduced an innovative surgical procedure: hilar dissection preserving the blood supply to the bile duct during donor hepatectomy. Compared with our previous outcomes (1990–2006), the biliary complication rate of the RL donors decreased from 12.2% to 7.2%, and the severity of these complications was significantly lower. In conclusion, LL donors demonstrated good recovery in postoperative liver function and lower morbidity, and our surgical innovations reduced the severity of biliary complications in living donors.     

肝中动脉的影像学解剖特点与活体供肝移植的相关性

目的 探讨在活体供肝移植中逐步受到重视的肝中动脉的解剖特点,以指导临床活体供肝移植的成功开展.方法 分析70例研究对象的64排螺旋CT资料,重点观察肝中动脉的解剖特点及变异情况.结果 肝中动脉在肝门部从其起源动脉发出后,走行于肝外,然后逐渐转至脐裂内门脉矢状部内侧,发出分支,主要供应肝4段.70例研究对象中,有49例(70%)存在肝中动脉.其中肝中动脉发自肝右动脉29例,占所有肝中动脉(n=49)的59.2%;发自肝左动脉17例,占34.7%;发自其它动脉3例(肝右前动脉、胃十二指肠动脉、肝固有动脉各1例),占6.1%.结论 肝中动脉的存在率高达70%,术前了解其解剖变异情况对于活体供肝移植手术方案的制定有重要指导作用.     

心脏外科围术期应用尼卡地平对心肌能量代谢的影响

目的观察尼卡地平对体外循环(CPB)后心肌能量代谢的影响.方法16例心脏瓣膜外科病人,随机分为对照组(C组,n=8)和尼卡地平组(N组,n=8).N组在麻醉诱导后,开始滴注小剂量尼卡地平(0.5μg@kg-1@min-1)至转机前,给予总剂量为0.5mg@kg-1,不足该剂量者,转机后即刻补足.在转机前即刻、开放主动脉后5min、30min、术毕、术后6h、18h,同时采集动脉血与冠状窦血,测定血乳酸、血糖、血气,由此计算心肌乳酸摄取率(LER)、心肌血糖摄取率(GER)及心肌摄氧指数(MOEI).结果与CPB前相比,C组主动脉开放后GER和LER均明显下降(P＜0.05),至术后6h仍未恢复正常.N组主动脉开放后,GER无明显变化且显著高于C组(P＜0.05);LER显著下降(P＜0.05),但明显高于C组(P＜0.05).两组开放主动脉5min后MOEI明显下降,随后显著恢复(P＞0.05).结论CPB可导致心肌乳酸和葡萄糖代谢受损及恢复延迟,小剂量尼卡地平可明显改善转流后心肌的乳酸与葡萄糖的代谢.     

Effective therapy for hepatic M. Osler with systemic hypercirculation by ligation of the hepatic artery and subsequent liver transplantation

Hereditary hemorrhagic teleangiectasia, or M. Osler (Osler-Weber-Rendu disease), is an autosomal dominant, systemic fibrovascular dysplasia. This may lead to increased liver blood flow from arteriovenous fistulas. A 45-year-old woman with a known M. Osler was admitted for liver transplantation. On admission, exertional dyspnea was the predominant symptom. Radiological investigations revealed multiple intrahepatic arteriovenous fistulas and consecutive high-output heart failure. Laboratory findings revealed remarkably elevated bilirubin and alkaline phosphatase. To alleviate the high-output cardiac failure, the hepatic artery was ligated. Fourteen months later, the patient presented again with increased levels of bilirubin and recurrent bleeding episodes from esophageal varices grade IV. The patient underwent liver transplantation and post-transplant recovery was excellent. A hyperdynamic circulatory state due to a hepatic M. Osler has been treated in several cases by ligation or embolization of the hepatic artery. This procedure, however, is recommended only for patients with normal liver function and carries a considerable risk of bile duct necrosis. Received: 25 November 1997 Accepted: 16 January 1998     

Cerebral blood flow and glucose metabolism in the squirrel monkey during the late phase of cerebral vasospasm

Summary A double-isotope autoradiography technique was used to evaluate cerebral blood flow (CBF) and cerebral glucose metabolism (CMRglu) during the late phase of vasospasm in a squirrel monkey subarachnoid haemorrhage (SAH) model. Cisternal blood injections induced both global and focal changes in CBF and CMRglu six days following SAH, the timepoint of maximal late spasm in this model. There was a global decrease in CBF of about 30% accompanied by an increase in deoxyglucose uptake of about 50%. Four of seven animals also had foci with flow decreased to 40% of control and deoxyglucose uptake increased to 300% of control. There was an altered but still present interdependence between flow and metabolism post SAH.     

肝星状细胞对大鼠肝部分切除术后肝再生修复的影响

目的 探讨肝星状细胞（hepatic stellate cells,HSCs）在大鼠肝部分切除术后对肝损伤修复的影响.方法 体外实验部分：将大鼠肝星状细胞（HSCs）与大鼠肝细胞系（BRL-3A）共培养,CCK-8比色法检测细胞增殖情况;ELISA法检测培养肝星状细胞上清液中细胞因子,即肝细胞生长因子（hepatic growth factor,HGF）、胰岛素样生长因子（insulin growth factor,IGF）、表皮细胞生长因子（epidermal growth factor,EGF）、转化生长因子-α（transfactor growth factor-α,TGF-α）含量.体内实验部分;将45只260 ～330 g健康雄性SD大鼠随机分为三组：正常组（生理盐水组）、对照组（肝星状细胞培养液组）、实验组（肝星状细胞培养上清液组）.各组分别于肝大部切除术后第3、7、12天取血清检测肝功能情况并计算肝再生指数;HE染色切片显微镜下观察肝脏病理结构改变情况;免疫组织化学染色法检测增殖细胞核抗原（proliferating cell nucleus antigen,PCNA）、平滑肌肌动蛋白（α-smooth muscle actin,α-SMA）、甲胎蛋白（a1pha feta1 protein,AFP）及白蛋白（albumin,ALB）的表达情况.结果 ①CCK-8法检测肝星状细胞能促进肝细胞增殖（P＜0.05）;②上清液较培养液中细胞因子HGF、TGF-α含量多,差别有统计学意义（P＜ 0.05）;③实验组肝再生指数比对照组大,差别具有统计学意义（P＜0.05）;④实验组大鼠AST随着时间的推移,较对照组下降明显,差别有统计学意义（P＜0.05）;⑤实验组PCNA表达量较正常组、对照组增多,差别有统计学意义（P＜ 0.05）;⑥平滑肌肌动蛋白、白蛋白、甲胎蛋白三组间差别不显著（P＞ 0.05）.结论 ①体外肝星状细胞能促进肝细胞增殖;②肝星状细胞培养上清液能促进大鼠肝部分切除术后肝再生,其分泌的多种细胞因子在肝损伤再生修复中起了重要作用.     

Benefit of Kupffer cell modulation with glycine versus Kupffer cell depletion after liver transplantation in the rat: effects on postischemic reperfusion injury, apoptotic cell death graft regeneration and survival.

Inhibition or destruction of Kupffer cells (KC) may protect against ischemia-reperfusion (IR) induced primary graft nonfunction (PNF) in liver transplantation. Besides KC activation, PNF is characterized by microvascular perfusion failure, intrahepatic leukocyte accumulation, cell death and hepatocellular dysfunction. KCs can be inactivated by different agents including gadolinium chloride (GdCl3), methyl palmitate (MP) and glycine. The effects of three KC inactivators on IR-injury after rat liver transplantation were compared in the present study. Lewis liver donors were treated with GdCl3, MP, glycine or saline (control). Liver grafts were transplanted following 24 h storage (UW solution). KC populations and IR damage were assessed by histologic analysis, quantitative real-time polymerase chain reaction (RT-PCR) and intravital microscopy. The number of hepatic ED-1 positive macrophages was diminished after GdCl3 (114.8+/-4.4/mm2 liver tissue) and MP treatment (176.0+/-5.0), versus the glycine (263.9+/-5.5) and control (272.1+/-5.6) groups. All three treatment modalities downregulated phagocytic activity for latex particles, paralleled by reduced microvascular injury (acinar perfusion index, GdCl3: 0.75+/-0.03; MP: 0.83+/-.03; glycine: 0.84+/-0.03; 0.63+/-0.03). Quantitative RT-PCR revealed elevated myeloperoxidase mRNA after glycine versus GdCl3 and MP pretreatment (3.2- and 3.4-fold, P=0.011, respectively), without difference to controls (2.9-fold of glycine). TNFalpha-mRNA was reduced after glycine- (5.2-fold), GdCl3- (19.7-fold), MP-treatment (39.5-fold) compared with controls. However, profound prevention of intrahepatic cell death and liver graft failure was solely achieved with glycine preconditioning. Different than GdCl3 and MP, glycine modulates rather than destroys KCs. Glycine appears to preserve cell viability and to TNFalpha/leukocyte dependent organ regeneration capacity, which is related to increase graft survival following liver transplantation.