Determination of hepatocellular enzymes in effluent of human liver grafts for preoperative evaluation of transplant quality

In 50 human livers harvested for transplantation, injury was assessed by determination of liver enzymes (lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, glutamate dehydrogenase, and creatine kinase) and of thrombomodulin in the effluent perfusate after cold ischemia, The results were compared with the morphology and the clinical course after transplantation. Whereas the release of the markers of endothelial cell injury correlated neither with the history of the graft nor with the postoperative course, the release of hepatocellular enzymes into the perfusate did indicate the severity of liver injury, even when biopsy showed normal liver tissue. Seven of 12 livers with high activities of hepatocellular enzymes in the effluent (activity of more than twice the median) showed delayed onset of function or primary nonfunction. In the other 38 livers with enzyme activities below this borderline, no delayed functioning or primary nonfunction was observed. Thus, determination of liver enzyme activities in the effluent makes it possible to identify those livers in which initial nonfunction is very unlikely, a potential that is especially valuable in livers shown by anamnesis or morphology to be of borderline quality.