Effect of perioperative infusion of antioxidants on neutrophil activation during liver transplantation in humans.

During orthotopic human liver transplantation (OLT), postreperfusion tissue damage is associated with a significant increase in markers of cytolysis and cholestasis and In the early phases of reperfusion an increase in the steady-state levels of reactive oxygen species (ROS) was observed to correlate with the presence of cytolysis; nevertheless, the role of oxidative stress in causing and/or amplifying postreperfusion damage to human liver grafts has not as yet been conclusively defined. The topology and chronology of the damage in the transplanted liver may be described as an endothelial cell injury that appears in the late stage of cold ischemia, followed immediately after reperfusion by involvement of the whole liver vasculature with concomittant activation of Kupffer cells, which, together with endothelial cells, attract and trigger polymorphonuclear cells (PMNs), the major source of ROS. While oxidative stress occurring in the hepatic vasculature appears to be a primary cause of the reperfusion injury, the role of oxidative reactions in phagocyte recruitment and activation is not yet clear. Hence, patients scheduled for OLT in two different transplantation units were randomly divided into two groups: one group received an intravenous dose of an antioxidant supplement during surgery. During the first 2 hours of reperfusion, we monitored blood indices of oxidative stress and neutrophil activation.