Increased exhaled carbon monoxide concentration during living donor liver transplantation

Takashi Matsusaki, Hiroshi Morimatsu, Toru Takahashi, Masaki Matsumi, Kenji Sato, Ryuji Kaku, Tetsufumi Sato, Takahito Yagi, Noriaki Tanaka, Kiyoshi Morita

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Exhaled carbon monoxide concentration (ExCO-C) has been reported to increase in oxidative tissue injuries such as systemic inflammation, and is thought to reflect increased heme breakdown in the affected organ. As a transplanted liver undergoes ischemia-reperfusion, we hypothesized that ExCO-C might also increase following liver transplantation and might serve as a measure of the severity of the graft tissue injury. We prospectively studied 67 living donor liver transplantation (LDLT) patients in a consecutive fashion. During anesthesia, ExCO-C was determined at 6 time points, ranging from anesthesia induction, to admission to the intensive care unit. We also measured two markers of endothelial cellular injury, i.e., serum soluble thrombomodulin (sTM) and intercellular adhesion molecule (ICAM)-1. At 5 min after reperfusion of the grafted liver, ExCO-C markedly increased from 5.69±2.34 ppm at baseline, to 9.79±4.72 ppm (p<0.0001). There was an excellent correlation among an increase in CO concentration, arterial carboxyhemoglobin levels at the time of reperfusion (r2=0.19, p=0.0003), and postoperative total bilirubin levels (day 1, 2, and 3; r 2=0. 102, 0.109 and 0.100; p=0.008, 0.007 and 0.010, respectively). Serum sTM and ICAM-1 levels were also significantly increased after reperfusion (sTM: 3.3±0.8 to 5.1±1.7 FU/ml, p=0.0001; ICAM-1: 271.9±86.3 to 515.0±157.8 FU/ml, p=0.0001). ExCO-C had a positive relationship with sTM (r2=0.16, p=0.035) and ICAM-1 (e=0.12, p=0.08). There was, however, no correlation of ExCO-C with serum AST/ALT levels or clinical outcomes. This study demonstrated that ExCO-C significantly increased after reperfusion during LDLT. The increased ExCO-C may likely reflect increased heme breakdown and endothelial cell injury in the grafted liver.

Original languageEnglish
Pages (from-to)75-81
Number of pages7
JournalInternational journal of molecular medicine
Issue number1
Publication statusPublished - Jan 2008


  • Bilirubin IXα
  • Carboxyhemoglobin
  • Endothelial cell injury
  • Heme oxygenase
  • Ischemia-reperfusion

ASJC Scopus subject areas

  • Genetics


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