Delayed liver function after transplantation (or lack of liver function) is caused by ischemia-reperfusion injury. Damage occurs during graft storage before transplantation at reduced temperature (4^◦C) and during warm reperfusion, i.e., resumption of blood perfusion. Oxygen free radicals are particularly destructive. The use of antioxidants can minimize the effects of oxidative stress. Antioxidants added to organ perfusion and preservation solution can neutralize reactive oxygen species. The purpose of this analysis was to evaluate the effectiveness of antioxidants in protecting the liver before transplantation based on a review of the literature.

Medline/PubMed, Embase, Cochrane Library, and Google Scholar databases were searched. Only peer-reviewed articles were included in the study. Synonym indexing of MeSH (Medical Subject Heading) and EMTREE (Elsevier's Life Science Thesaurus) was used. Keywords used were: transplantation, liver, solution preservation, free radicals, ischemia-reperfusion injury, antioxidants. Articles published between January 2000 and October 2021 were included in the analysis.

We found a relationship between the efficacy of the preservative solution and its composition. The addition of antioxidant (quercetin, l-carnitine, phycocyanin, trimethazidine, SkQ1 (10-(6′-plastoquinonyl)decyltriphenylphosphonium), rMnSOD (manganese superoxide dismutase)) protects hepatocytes from oxidative stress and stabilizes mitochondrial structures.

Antioxidants added to preservative solution minimize ischemia-reperfusion injury to hepatocytes.