Agrimoniin Alleviates Ferroptosis in Cold-Stored DCD Liver Grafts Through Activation of the Nrf-2 Pathway

Liver grafts from donation-after-cardiac-death (DCD) are vulnerable to ischemia-reperfusion injury, which compromises graft function after transplantation. Agrimoniin has been shown to possess antioxidant and anti-inflammatory properties, making it a potential therapeutic agent for organ preservation. This study investigated whether supplementing agrimoniin to the University of Wisconsin (UW) cold storage solution protected liver grafts from DCD rats or cold preserved human liver cell lines (QSG-7701 and HepG2). Agrimoniin supplementation significantly reduced oxidative damage, alleviated ferroptosis, and mitigated liver injury by activating the Nrf-2 pathway, both in vivo and in vitro. These findings suggest that ferroptosis is a mediator in DCD liver injury, and agrimoniin, through its activation of the Nrf-2 pathway, may be an effective therapeutic agent for enhancing liver graft preservation and improving outcomes in DCD liver transplantation.