Renalase a Potential Marker of Ischemia Reperfusion Injury Post Living Donor Liver Transplantation

Abstract
Background: Ischemia refers to diminished blood supply, causing a lack of oxygen and when blood supply is re-established this is reperfusion. The Ischemia-Reperfusion (I/R) process is a common event after living donor liver transplantation, trauma, and hemorrhagic shock. Renalase, a ubiquitous flavoprotein, is highly expressed in kidney, liver, heart, skeletal muscles and adipose tissues. Renalase has been verified that it is the only enzyme involved in the catecholamine metabolism that can be secreted into the blood cycle hitherto.
Considering renalase close relationship with oxidative stress, renalase is thought to play a role, or at least responsive, in the process of hepatic ischemia reperfusion injury.
Aim of Study: To demonstrate whether serum Renalase can be used as a potential biomarkers of hepatic ischemia reperfusion injury following living donor liver transplantation especially when combined with the standard LFT panel.
Patients and Methods: The present study was conducted on 50 patients with End Stage Liver Disease (ESLD) under-going Living Donor Liver Transplantation (LDLT). Patients were evaluated pre-operatively laboratory by using the Child-Pugh score and Model for End-Stage Liver Disease (MELD) Score and radiological by abdominal Doppler ultrasonography. Intra-operative evaluation of patients included: Operative details including ischemia time, intraoperative bleeding and amount of blood transfused. Post-operative workup included daily examinations as regards vital signs, drains and fluid balance. Daily measurement of CBC, LFT and KFT was done for seven days.
Results: By comparing different laboratory data day seven to laboratory data on day one post-living donor liver trans-plantation, there was a statistically significant decline regarding AST, ALT, INR reflecting graft function, our study demon-strated no statistically significant correlation between serum Renalase levels and operative ischemia time predisposing to ischemia reperfusion injury.
Conclusion: Clinical treatment decisions based on the serial detection of renalase activities in the blood did not help in early detection and possible prevention of hepatic ischemia reperfusion injury post-living donor liver transplantation to improve the clinical outcomes of liver transplantation.