High-Na + low-K + UW cold storage solution reduces reperfusion injuries of the rat liver graft

The isolated perfused rat liver model was used to assess graft viability after 24 h of cold preservation. Two solutions were compared for liver preservation: Belzer's original UW solution (high-K ⁺ UW) and a solution containing the same components but with inverted concentrations of sodium and potassium (high-Na ⁺ UW). During the 120 min of normothermic reperfusion, livers preserved in the high-Na ⁺ UW solution released lower levels of creatine kinase-BB isoenzyme, transaminases (ALT and AST), and potassium than those preserved in the high-K ⁺ UW solution. Bile flow and biliary excretion of indocyanine green increased when livers were preserved in the high-Na ⁺ UW solution. We found no statistical differences for oxygen consumption and tissue ATP concentration. The results of this study support the concept that a high-Na ⁺ UW solution is a more effective means of preserving rat livers, at least after 24 h of cold-storage and 120 min of reperfusion in the isolated perfused model, than the original high-K ⁺ UW solution. Liver preservation in the high-Na ⁺ UW solution reduces damage to sinusoidal endothelial and hepatocellular cells. The use of an extracellular-like Belzer cold storage solution eliminates potassium-related problems in cold preservation and subsequent normothermic reperfusion while keeping all the qualities of the original UW solution. Received: 26 August 1997 Received after revision: 12 November 1997 Accepted: 28 November 1997     

UW器官保存液在胰腺移植中的研究进展

近年来,糖尿病发病率在全球呈快速增长的趋势,我国患病率已达到3%.多数Ⅰ型和部分Ⅱ型糖尿病患者需要采用外源性胰岛素注射控制血糖,患者不但要承受胰岛素注射带来的痛苦,而且还不可避免地要发生远期的并发症.因此,重建内源性胰岛分泌系统是近年来人们关注的热点.大量实验表明,胰腺移植不但可以中止胰岛素依赖性糖尿病并发症的发展,还可以转归已有的并发症,明显改善患者的预后.与其他器官移植一样,移植器官的获取及保存是移植成功的前提,由于胰腺组织的特殊性,不同的器官保存液对于保存胰腺效果不一.本文将对University of Wisconsin(UW)保存液在胰腺移植中作用作一论述.     

Liver graft preservation:an overview

Liver graft preservationT he viability of the organ and its maintenance are very important during any transplant procedure and there is usually a period between the stoppage of the circulation in the donor and re-vascularisation of the organ in the recipient. During this period the harvested organ may have an irreversible harmful series of events rendering it not suitable for transplantation. This non-reversible damage which occurs during the ischaemic period depends partly on the metabolic re…     

13例原位心脏移植术中长时间心肌缺血的心肌保护和术后近期效果

目的 :总结分析 13例原位心脏移植手术中心肌缺血时间大于 2 4 0min的心肌保护技术和术后近期疗效。方法 2 0 0 0年 5月～ 2 0 0 4年 9月连续为 79例患者进行原位心脏移植术 ,其中 13例心肌缺血时间大于 2 4 0min。本组术前心功能均为Ⅳ级。手术按标准法行原位心脏移植手术 2例 ,行双腔静脉吻合法移植手术 11例。心肌缺血时间在 2 4 0～ 383min ,平均 (312± 4 2 )min。供心的保护方法包括在主动脉阻断时经主动脉根部灌注晶体停搏液 ,在取下心脏后 ,再次灌注UW液 ,并置于UW液中保存。结果 :本组无手术死亡。术后均获完整随访 ,随访时间 1个月～ 3年 ,平均 8.2个月 ,术后无死亡 ,所有病人心功能均恢复至I～II级。结论 :我们所采取的心脏获取和心肌保护方法 ,加之合适的供体、受体选择 ,双腔静脉吻合技术 ,以及加强术中、术后监测和处理 ,长时间心肌缺血的病人可获得满意的早期疗效。     

Protective strategies against ischemic injury of the liver

This article summarizes strategies to protect the liver from injuries caused by ischemia and reperfusion. Three different sections (i.e., surgical and pharmacologic strategies and gene therapy) present approaches to enhance the survival and viability of the liver in various surgical procedures including liver transplantation. The first section reviews approaches using surgical interventions such as ischemic preconditioning and intermittent clamping. Their protective effects are discussed with respect to the mechanism of injury. In the second section, pharmacologic agents targeting microcirculation, oxidative stress, proteases, and inflammation are described. Mechanisms of injury and their suppression by a wide variety of drugs are discussed. The third section focuses on gene therapy. Potential target genes have been identified (e.g., superoxide dismutase or heme oxygenase). Animal experiments in which the liver injury is reduced successfully may pave the way to novel strategies applied to different liver diseases in humans.     

异体脸面复合组织移植供体保存的研究

目的 探讨异体脸面部复合组织移植供体的有效保存方法，以减轻组织缺血缺氧损伤。方法 取狗的脸面部复合组织瓣，分别用4℃生理盐水和UW液灌注、保存，用MTT法检测复合组织瓣取下即刻、保存12、24、48h的各组织的活力，计算其与未保存组织相比的活力百分比，并进行病理学观察。结果 各种组织用UW液保存48h后活力仍为未保存组织的75％以上。保存后24、48h活力百分比与生理盐水组比较差异有统计学意义（P〈0．05）。病理切片示保存24、48h，生理盐水组皮肤、黏膜组织真皮层纤维排列疏松，轻度水肿，皮肤毛囊周围可见组织玻璃化，毛囊内可见细胞水肿，肌束间间隙扩大，腺体有部分腺泡细胞界限模糊，其他组织未见明显变化；UW液组各组织未见明显组织学变化。结论 UW液可以考虑用于临床异体脸面部复合组织瓣保存的保存液。     

Comparison of University of Wisconsin (UW) and Eurocollins (EC) preservation solutions in a rat liver transplant model

The Eurocollins (EC) and University of Wisconsin (UW) preservation solutions were compared in a rat liver transplant model. After hepatectomy, 48 rat livers were flushed with either EC or UW preservation solution and were randomly assigned to 1, 12, 24, and 30 h of preservation at 4°C, resulting in eight groups each containing six livers. Following preservation, orthotopic liver transplantation with reconstruction of the hepatic artery was performed. The efficacy of the preservation solution was assessed at 48 h post-transplantation by survival histological features and aspartate transaminase assay (AST) values. None of the rats survived 30 h of liver preservation with EC whereas five out of six rats did with UW preservation. After 24 h of liver preservation, three of the six rats in the EC group survived, compared to all six rats in the UW group. Histological evidence of severe ischemia was found in both groups in all but one survivor (UW, 24 h). After 12 h of EC preservation, one rat died within 48 h and severe ischemic changes were found in the remaining five rats. Among the rats with 12 h of UW preservation, only two out of six showed ischemic changes, and all six rats survived beyond 48 h. Without preservation (1 h), ischemic damage was found in two out of six rats in each group and all rats survived. The median AST values were higher in the EC groups than in the UW groups; the difference became significant after 12-h preservation (EC 900 IU/l versus UW 465 IU/l) and 24-h preservation (EC 5220 IU/l versus UW 631 IU/l). However, the median AST value in the five surviving rats whose livers had been preserved for 30 h in UW climbed to 1880 (950–2240) IU/l.. We conclude that UW solution provides better long-term preservation than EC solution. However, even with UW solution, the observed mortality, the severity of ischemic changes, and the pronounced increase in the median AST value cast doubt upon the safety of liver preservation beyond 24 h.     

Postoperative recovery of mitochondrial function of the human liver graft procured and preserved with University of Wisconsin (UW) solution

Abstract. Changes in arterial blood ketone body ratio (KBR) were investigated in 47 human liver transplantations. Of the 20 grafts preserved with University of Wisconsin (UW) solution, 10 had a cold preservation period of less than 10 h (UWS group) and 10 of more than 10 h (UWL group). In 27 other cases, grafts were preserved with EuroCollins (EC) solution for less than 10h (EC group). In the EC group, KBR increased over 0. 7 within 6h after reperfusion of the graft in 17 cases (63%) and within 24 h in 7 cases (26%). In the 3 other cases, KBR failed to recover, and these patients underwent retransplantation. In the UW group, KBR recovered within 6 h in 13 cases (65%) and within 24 h in 7 cases (35%). There were no significant differences between the UWS and UWL groups. It is shown that the mitochondrial function of liver grafts preserved with UW solution can be well maintained even after extended preservation periods of more than 10 h.