Discussion
AKI, biliary complications
CDA, SURGICAL COMPLICATIONS, COLD, SYNDROME
In this RCT, we did not find evidence that an add-on perioperative combination drug regimen delivered to the graft immediately before implantation and to the recipient attenuated the degree of IRI. In addition, no differences were found in postreperfusion syndrome, histological IRI score, liver function, and the frequencies of severe surgical complications, IC, AKI, and acute cellular rejection, and graft and patient survival were similar between groups.These findings were in contrast with those in the proof-of-concept study,Physiological differences between pigs and humans and the highly controlled and reproducible conditions of experimental models as opposed to the variability in IRI severity in the clinical setting may explain why the protective effect observed in pigs was not reproduced in this study of humans. Another factor to explain the discrepancy between the porcine model and this RCT is that the porcine studyPerhaps the design of the CDA, adapted to the clinical setting, may be another plausible explanation for the difference in results. In the proof-of-concept study,To translate the CDA regimen from the experimental to clinical setting, changes in drug composition were made, which may also have contributed to a variability in effect. The different agents, doses, and time regimens were judiciously chosen based on published evidence of their biological efficacy and pharmacokinetics (Recent developments in liver transplantation have included significant progress in the preservation of liver grafts by using dynamic preservation strategies. Preclinical and clinical studies have shown that compared with static cold storage, dynamic preservation allows for a reduction in IRI severity, frequencies of biliary complications and EAD, hospital stay, and graft and patient survival.