供体热缺血时间对移植肝的影响

目的 探讨大鼠动脉化原位肝移植中供体热缺血时间对移植肝的影响.方法 实验分为4组:对照组(C)和移植组,移植组根据供肝获取前经历供体心脏停搏时间的不同分为三组:热缺血0 min(W0)、热缺血15 min(W15)和热缺血30 min(W30),其后建立近交系大鼠动脉化原位肝移植模型,每组均为30只大鼠,分别于术后3、7、14和30 d处死,每个时间点各取6只大鼠,分别测定移植肝组织学、肝功能的变化.此外,移植组各组随机选取6只大鼠观察长期生存率(＞100 d).结果 随着供肝热缺血时间的延长,移植肝损伤加重,恢复过程延长.移植组和对照组术后3、7、14和30 d血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)变化无显著性差异.血清碱性磷酸酶(ALP)随着供肝热缺血时间的延长逐渐增高,14 d达到高峰后逐渐下降.术后3、7、14和30 d ALP与供肝热缺血时间具有显著相关性.术后热缺血0、15、30 min长期生存率组分别为100.0%(6/6)、83.3%(5/6)、66.7%(4/6),3组间比较差异无统计学意义(P=0.285).结论 肝移植过程中供肝热缺血主要损伤肝细胞,并随着供肝热缺血时间的延长移植肝细胞损伤加重,肝细胞功能恢复早于其形态学恢复.肝移植术后早期存在胆汁淤积,供肝热缺血时间的延长明显加重胆汁淤积的程度,胆汁淤积的恢复明显晚于肝细胞损伤指标的恢复.在热缺血30 min内来自于心脏停搏的供肝肝移植术后是安全的.

The effect of donor warm ischemia time on liver graft

Objective To study the effect of donor warm ischemia time on liver graft in rat orthotopic liver transplantation with arterial reconstruction.Methods Lewis rats were divided into four groups(n= 30/group) including control group and 3 liver transplantation groups in which cardiac arrest time was respectively 0,15,30 min(W0,W15,W30),then the model of rat orthotopic liver transplantation with arterial reconstruction was established.To evaluate histology,hepatic function,6 rats in each group were sacrificed on 3,7,14 and 30 days after surgery respectively.The long-term survival (longer than 100 days)rate were compared (n=6) among liver transplantation groups.Results Histological studies showed that with increased warm ischemia time,the recovery of liver function delayed,liver parenchyma injury aggravated.There were no significant difference in serum levels of ALT and AST among all groups on 3,7,14 and 30 days after surgery.ALP level elevated with increased warm isehemia time of the graft and peaking on day 14 postoperatively.The correlation between the warm isehemia time of the graft and serum ALP level was observed.The long-term survival of W0,W15 and W30 were 100.0% (6/6),83.3% (5/6),66.7% (4/6) respectively,with liver abscess as the main canse of death.Conclusion Hepatocytes were what most severely injured by the process of warm ischemia.The injury aggravated with increased warm ischemia time.The recovery of liver function was faster than that of the morphology.Cholestasis was evident after liver transplantation at early phase and aggravated with increased warm ischemia time of the graft.Biochemical signs of cholestasis restored slower than markers of hepatocyte injury.It is safe to use a liver graft in transplantation harvested from a donor suffering from a warm ischemia up to 30 minutes.