Glycocalyx as a Useful Marker of Endothelial Injury in Liver Transplantation: The Role of Preservation Solution

The reported investigations from Schiefer et al,1 on the role of glycocalyx (GC) in orthotopic liver transplantation, propose GC as a relevant injury marker to be used in this field. GC is a complex sugar monolayer, which covers the endothelium and is thus exposed and susceptible to alteration as a consequence of liver ischemia-reperfusion (IR) injury associated with orthotopic liver transplantation. The authors have used histidine-tryptophan-ketoglutarate (HTK) solution in their study. However, other preservation solutions (PSs) with different compositions (such as University of Wisconsin [UW], Celsior, and IGL-1 PS) are commercially available and should be tested. Extension of the study with use of these alternative PS could provide important insights into organ PS. The presence of an oncotic agent (such as hydroxyethyl starch in the UW solution or polyethylene glycol 35 [PEG35] in IGL-1 solution) differentiates UW and IGL-1 from HTK and Celsior solutions, which do not contain oncotic agents. This difference is relevant because oncotic pressure, controlled by the oncotic agent, minimizes interstitial edema, which could directly affect GC. However, the oncotic agent increases viscosity, which may in turn affect the protective performance of the PS. Balancing the limitation of edema against viscosity during organ preservation is critical to GC integrity and graft status