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2016 ; 48
(ä): 92-98
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Ischemia reperfusion-facilitated sinusoidal endothelial cell injury in liver
transplantation and the resulting impact of extravasated platelet aggregation
#MMPMID27110233
Miyashita T
; Nakanuma S
; Ahmed AK
; Makino I
; Hayashi H
; Oyama K
; Nakagawara H
; Tajima H
; Takamura H
; Ninomiya I
; Fushida S
; Harmon JW
; Ohta T
Eur Surg
2016[]; 48
(ä): 92-98
PMID27110233
show ga
BACKGROUND: The exact sequence of events leading to ultimate hepatocellular
damage following ischemia/reperfusion (I/R) is incompletely understood. In this
article, we review a mechanism of organ dysfunction after hepatic I/R or
immunosuppressive treatment, in addition to the potential of liver sinusoidal
endothelial cell (LSEC) protection and antiplatelet treatment for the suppression
of hepatocellular damage. METHODS: A review of the literature, utilizing
PubMed-NCBI, was used to provide information on the components necessary for the
development of hepatocellular damage following I/R. RESULTS: It is
well-established that LSECs damage following hepatic I/R or immunosuppressive
treatment followed by extravasated platelet aggregation (EPA) is the root cause
of organ dysfunction in liver transplantation. We have classified three phases,
from LSECs damage to organ dysfunction, utilizing the predicted pathogenic
mechanism of sinusoidal obstruction syndrome. The first phase is detachment of
LSECs and sinusoidal wall destruction after LSECs injury by hepatic I/R or
immunosuppressive treatment. The second phase is EPA, accomplished by sinusoidal
wall destruction. The various growth factors, including thromboxane A2,
serotonin, transforming growth factor-beta and plasminogen activator inhibitor-1,
released by EPA in the Disse's space of zone three, induce portal hypertension
and the progression of hepatic fibrosis. The third phase is organ dysfunction
following portal hypertension, hepatic fibrosis, and suppressed liver
regeneration through various growth factors secreted by EPA. CONCLUSION: We
suggest that EPA in the space of Disse, initiated by LSECs damage due to hepatic
I/R or immunosuppressive treatment, and activated platelets may primarily
contribute to liver damage in liver transplantation. Endothelial protective
therapy or antiplatelet treatment may be useful in the treatment of hepatic I/R
following EPA.