Acute blood leukocyte reduction after liver reperfusion: a marker of ischemic injury

INTRODUCTION: Reperfusion injury occurs after ischemic storage of the liver. The release of free radicals from endothelial cells leads to increased adherence of polymorphonuclear neutrophils to endothelium and further release of proteases and free radicals that alter the microcirculation and produce graft dysfunction. Acute blood leukocyte reduction after reperfusion may be an expression of this sequestration and activation of neutrophils within hepatic sinusoids. This study sought to evaluate whether reduction in white blood cells occurring immediately after reperfusion was a marker of poor graft preservation and postoperative dysfunction. METHODS: The leukocyte count was evaluated at the end of anhepatic phase and at 5 minutes after reperfusion among 65 patients undergoing liver transplantation. Group A included patients with a leukocyte reduction between the two phases greater than 50%; group B, patients with less than 50%. Hepatic enzymes, blood lactate (60 and 120 minutes after graft reperfusion) and factor V and VII and bilirubin levels (daily for 15 days after transplantation) were compared between groups to assess graft injury and postoperative dysfunction. RESULTS: Alanine aminotransferase levels were significantly higher among group A than group B at both 60 and 120 minutes after graft reperfusion. No differences were observed in lactate, and factor V and VII levels. Total bilirubin was significantly higher among group A than group B patients at 10 and 15 days postoperative. CONCLUSIONS: The acute blood leukocyte reduction after reperfusion, probably due to sequestration and activation into hepatic sinusoids, seemed to be an early intraoperative marker for poor graft preservation and function.