Endothelial-Related Gene Expression Plays a Role Against Acute Kidney Injury and Prolonged Intensive Care Stay in Liver Allografts Treated with Hypothermic Oxygenated Perfusion

Background: Hypothermic oxygenated perfusion (HOPE) has emerged as a promising preservation strategy before liver transplantation, mitigating ischemia-reperfusion injury and improving graft function, especially in marginal grafts and donors after cardiac death. Methods: This is a prospective monocentric study; 34 HOPE-treated liver grafts were enrolled and analyzed through histopathology and RT-PCR to assess endothelial-related gene expression and its correlation with post-transplant outcome. The aim of the present study was to assess the relationship between the expression of genes related to vascular activation and homeostasis and post-transplant clinical characteristics. Results: Expression of SMA and TGF-β1 was significantly associated with arteriolar myointimal thickening of the graft (p = 0.007 and 0.068). Higher expression of SMA, ERG, and TGF-β1 was correlated with a shorter post-operative intensive care stay (p = 0.070, p = 0.010 and p = 0.029, respectively), particularly with post-transplant acute kidney injury. Conclusions: These findings highlight the role of endothelial activation and vascular homeostasis for an early recovery after liver transplantation, posing an important issue for healthcare systems as well, and suggesting molecular markers for graft assessment and risk stratification.