{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:00:15Z","timestamp":1793073615100,"version":"4.5.0"},"reference-count":58,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T00:00:00Z","timestamp":1711584000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016220","name":"Georgia Clinical and Translational Science Alliance","doi-asserted-by":"publisher","award":["UL1TR002378"],"award-info":[{"award-number":["UL1TR002378"]}],"id":[{"id":"10.13039\/100016220","id-type":"DOI","asserted-by":"publisher"}]},{"name":"International Liver Transplantation Society","award":["Vanguard Research Award sponsored by Natera"],"award-info":[{"award-number":["Vanguard Research Award sponsored by Natera"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Early allograft dysfunction (EAD) is a functional hepatic insufficiency within a week of orthotopic liver transplantation (OLT) and is associated with morbidity and mortality. The etiology of EAD is multifactorial and largely driven by ischemia reperfusion injury (IRI), a phenomenon characterized by oxygen scarcity followed by paradoxical oxidative stress and inflammation. With the expanded use of marginal allografts more susceptible to IRI, the incidence of EAD may be increasing. This necessitates an in-depth understanding of the innate molecular mechanisms underlying EAD and interventions to mitigate its impact. Our central hypothesis is peri-reperfusion hyperoxemia and immune dysregulation exacerbate IRI and increase the risk of EAD. We will perform a pilot prospective single-center observational cohort study of 40 patients. The aims are to determine (1) the association between peri-reperfusion hyperoxemia and EAD and (2) whether peri-reperfusion perturbed cytokine, protein, and hypoxia inducible factor-1 alpha (HIF-1\u03b1) levels correlate with EAD after OLT. Inclusion criteria include age \u2265 18 years, liver failure, and donation after brain or circulatory death. Exclusion criteria include living donor donation, repeat OLT within a week of transplantation, multiple organ transplantation, and pregnancy. Partial pressure of arterial oxygen (PaO<jats:sub>2<\/jats:sub>) as the study measure allows for the examination of oxygen exposure within the confines of existing variability in anesthesiologist-administered fraction of inspired oxygen (FiO<jats:sub>2<\/jats:sub>) and the inclusion of patients with intrapulmonary shunting. The Olthoff et al. definition of EAD is the primary outcome. Secondary outcomes include postoperative acute kidney injury, pulmonary and biliary complications, surgical wound dehiscence and infection, and mortality. The goal of this study protocol is to identify EAD contributors that could be targeted to attenuate its impact and improve OLT outcomes. If validated, peri-reperfusion hyperoxemia and immune perturbations could be targeted via FiO<jats:sub>2<\/jats:sub> titration to a goal PaO<jats:sub>2<\/jats:sub> and\/or administration of an immunomodulatory agent by the anesthesiologist intraoperatively.<\/jats:p>","DOI":"10.1371\/journal.pone.0301281","type":"journal-article","created":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T17:34:04Z","timestamp":1711647244000},"page":"e0301281","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["OXIDATIVE study: A pilot prospective observational cohort study protocol examining the influence of peri-reperfusion hyperoxemia and immune dysregulation on early allograft dysfunction after orthotopic liver transplantation"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8105-0928","authenticated-orcid":true,"given":"Elizabeth A.","family":"Wilson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0644-6049","authenticated-orcid":true,"given":"Anna","family":"Woodbury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten M.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2400-3217","authenticated-orcid":true,"given":"Craig M.","family":"Coopersmith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,3,28]]},"reference":[{"key":"pone.0301281.ref001","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1002\/lt.22091","article-title":"Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors","volume":"16","author":"KM Olthoff","year":"2010","journal-title":"Liver Transpl"},{"issue":"3","key":"pone.0301281.ref002","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1002\/hep4.1651","article-title":"Early allograft dysfunction increases hospital associated costs after liver transplantation\u2013a propensity score-matched analysis","volume":"5","author":"S Moosburner","year":"2021","journal-title":"Hepatol Commin"},{"key":"pone.0301281.ref003","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/00007890-199808150-00005","article-title":"Early allograft dysfunction after liver transplantation: a definition and predictors of outcome. 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