Golling M, Bud O, von Frankenberg M, Ulrich F, Schäffer F, Weiss G, Mehrabi A, Kraus T, Urbaschek R, Gebhard M M, Herfarth C, Klar E
Department of General Surgery, University of Heidelberg, Germany.
Transpl Int. 2000;13 Suppl 1:S600-4. doi: 10.1007/s001470050411.
The study was designed to assess the gastrointestinal ischaemia and the influence of the specific Kupffer cell toxin gadolinium chloride (GdCl3) on the hepatic and extrahepatic endotoxin [lipopolysaccharide (LPS)] clearance during experimental orthotopic liver transplantation (OLT) in pigs. In eight pig liver transplantations, the donors received 20 mg/kg of GdCl3 24 h before explantation, while controls (n = 8) received normal saline. Gastric and sigmoid intramucosal pH (pHi), LPS and endotoxin-neutralising capacity (ENC) levels were measured in the portal vein and superior vena cava after laparatomy, at the end of the anhepatic phase and 1 h after reperfusion. During the anhepatic phase, the sigmoid pHi decreased significantly from 7.32 +/- 0.02 to 7.29 +/- 0.03 (P < 0.001) and was associated with a substantial increase of portal LPS. Following reperfusion, the systemic LPS concentrations were significantly lower in the pretreated group [39 +/- 23 pg/ml (Control); 14 +/- 7 (GdCl3); P < 0.05] suggesting an improved liver LPS clearance [86% (GdCl3); 58.2% (Control); P < 0.05]. This corresponded to an increased ENC in the pretreated group [118 +/- 52 ENU/ml (GdCl3) vs 81 +/- 45 ENU/ml (Control); P < 0.05]. The anhepatic phase induced splanchnic ischaemia which correlated with portal endotoxaemia. Donor preconditioning with GdCl3 leads to lower systemic LPS concentrations in the recipient and increases ENC values in the early phase after OLT. An improved hepatocellular LPS extraction and/or an activation of the extrahepatic reticulo-endothelial system as a result of GdCl3 treatment is discussed.
本研究旨在评估猪原位肝移植（OLT）过程中胃肠道缺血情况，以及特异性枯否细胞毒素氯化钆（GdCl3）对肝内和肝外内毒素[脂多糖（LPS）]清除的影响。在8例猪肝移植中，供体在切取肝脏前24小时接受20mg/kg的GdCl3，而对照组（n = 8）接受生理盐水。在开腹后、无肝期末和再灌注后1小时，测量门静脉和上腔静脉中的胃和乙状结肠黏膜内pH（pHi）、LPS及内毒素中和能力（ENC）水平。在无肝期，乙状结肠pHi从7.32±0.02显著降至7.29±0.03（P < 0.001），并伴有门静脉LPS的大幅增加。再灌注后，预处理组的全身LPS浓度显著低于对照组[39±23pg/ml（对照组）；14±7（GdCl3组）；P < 0.05]，提示肝脏对LPS的清除有所改善[86%（GdCl3组）；58.2%（对照组）；P < 0.05]。这与预处理组ENC的增加相对应[118±52ENU/ml（GdCl3组）对81±45ENU/ml（对照组）；P < 0.05]。无肝期诱导了内脏缺血，这与门静脉内毒素血症相关。供体用GdCl3预处理可导致受体全身LPS浓度降低，并在OLT后的早期增加ENC值。讨论了GdCl3处理导致肝细胞对LPS提取改善和/或肝外网状内皮系统激活的情况。
