Related Experiment Video
Updated: Aug 13, 2026
Vascular Reconstruction with the Cuff Technique in Mouse Orthotopic Liver Transplantation
Published on: December 1, 2023
Graft protein C entrapment is associated with reduced phagocyte activation during reperfusion in human liver
Minna Ilmakunnas1, Eero J Pesonen, Krister Höckerstedt
1Transplantation and Liver Surgery Clinic, Fourth Department of Surgery, Helsinki University Central Hospital, Finland.
Objective:
To explore the potential anti-inflammatory role of protein C pathway in ischemia-reperfusion injury during liver transplantation.
Design:
Prospective, observational clinical study.
Setting:
Tertiary teaching hospital.
Patients:
Fifty adult patients undergoing liver transplantation for acute liver failure or chronic liver disease.
Interventions:
To assess changes occurring across the transplanted liver, samples of blood entering and leaving the graft were obtained simultaneously from portal and hepatic veins. Plasma protein C and activated protein C levels, neutrophil and monocyte CD11b and L-selectin expression, and leukocyte differential counts were measured. Postoperative liver function and outcome of transplantation were recorded.
Measurements And Main Results:
During reperfusion, protein C became entrapped within the graft (portal vein 49% [20-96%]; graft caval effluent 25% [12-76%], p < .001), without concomitant activated protein C outflow from the graft. Simultaneously, marked neutrophil and monocyte activation occurred within the graft. Enhanced hepatic protein C entrapment was associated with reduced neutrophil and monocyte activation (R = .377, p = .011; R = .389, p = .008, respectively) during reperfusion.
Conclusions:
Protein C entrapment occurs immediately during reperfusion in the graft without concomitant activated protein C release, suggesting a shortage of activated protein C in the reperfused graft. The ongoing inflammatory response during reperfusion may lead to protein C and activated protein C utilization within the graft. Indeed, hepatic protein C entrapment is associated with reduced hepatic phagocyte activation, suggesting a regulatory role for protein C pathway in hepatic reperfusion in human liver transplantation.
