Glycocalyx kinetics and injury during liver procurement and transplantation are predictive of early graft dysfunction

Nassiba Beghdadi^1*Alexis Texier²Marc Antoine Allard¹Mylene Sebagh¹Nour Bousaleh¹Haitham Triki¹Daniel Pietrasz¹Nicolas Cabrit¹Nicolas Golse¹René Adam¹Cyrille Feray¹Peter J Lenting²Stéphanie Roullet^1,2Daniel Azoulay¹

• ¹Hopital Paul Brousse, Villejuif, France
• ²INSERM UMR-S1176, Le Kremlin-Bicêtre, France

Introduction: Ischemia-reperfusion injury causes endothelial damage, partly through degradation of the glycocalyx. This study aimed to evaluate glycocalyx degradation from graft procurement to reperfusion and assess its value as a biomarker of early graft function (EAD). Methods: A single-center observational prospective study conducted at Paul Brousse Hospital (April 2022 to April 2023). All primary liver transplantation (LT) recipients were included. Glycocalyx degradation was assessed at procurement, end of cold ischemia, and during LT in liver graft caval effluent and was correlated with liver histological injury. The primary endpoint was EAD based on the Model for Early Allograft Function (MEAF) score ≥9. We quantified glycocalyx components (Syndecan-1 (Synd-1), heparan sulfate, angiopoietin-1 & -2), inflammation (TNF-alpha) and cell death markers. Results: Thirty-one patients were included; 12 (39%) developed EAD. Synd-1 level in plasma was significantly higher at procurement (donor Synd-1 level=d-Synd-1) in patients with EAD (12 173 pg/mL (10 538-17 570) vs 6 282 pg/mL (4 604-10 002), p= 0.004). d-Synd-1 cutoff in plasma of 9419.7 pg/mL predicted EAD (AUC= 0.81 IC95% (0.65-0.97); Sensitivity 83%; Specificity 74%, PPV=67%, NPV=88%, p<0.05). d-Synd-1 ≥ 9419.7 pg/mL was associated with severe post LT complications (p=0.007). Conclusions: d-Synd-1 level in graft effluent during procurement may predict early allograft dysfunction. Endothelial protection during procurement could improve graft outcomes.