Pattou F, Boudjema K, Kerr-Conte J, Barguil Y, Friese N, Wolf P, Jaeck D, Cinqualbre J
Laboratoire de Chirurgie Expérimentale, Fondation Transplantation, Strasbourg.
Presse Med. 1992 Dec 2;21(41):2012-4.
It has been suggested that depletion of donor hepatic glycogen reserves deleteriously affects the resistance of the hepatic graft to ischemic episodes. In this study, performed in the pig model, we showed that it is possible to enhance the quality of the graft at the time of reperfusion by using a method which rapidly restores the donor hepatic glycogen reserves. With the aid of an isolated liver perfusion model, we compared grafts (n = 24) harvested from pigs fed (group N), fasted for 24h (group J), or fasted with a restoration of glycogen reserves (group P). After the grafts were subjected to 8 hours of cold ischemia, the release of alanine aminotransferase, aspartate aminotransferase and lactic dehydrogenase in the perfusate increased in group J (P < 0.05 vs group N); the increase was corrected in group P (P < 0.05 vs group J). When the grafts were subjected to 15 minutes warm ischemia prior to the liver harvest, the production of bile was reduced in group J (P < 0.05 vs group N); bile production was reestablished in group P (P < 0.05 vs group J). The clinical application of such a method of donor nutritional conditioning, in the hours which precede organ harvesting, may enhance the quality of the hepatic graft at the time of transplantation.
有人提出，供体肝糖原储备的耗竭会对肝移植器官抵抗缺血事件的能力产生有害影响。在这项以猪为模型进行的研究中，我们表明，通过一种能迅速恢复供体肝糖原储备的方法，可以在再灌注时提高移植器官的质量。借助离体肝脏灌注模型，我们比较了从喂食的猪（N组）、禁食24小时的猪（J组）或禁食后糖原储备得以恢复的猪（P组）获取的移植器官（n = 24）。在移植器官经历8小时冷缺血后，J组灌注液中丙氨酸转氨酶、天冬氨酸转氨酶和乳酸脱氢酶的释放增加（与N组相比，P < 0.05）；P组的这种增加得到了纠正（与J组相比，P < 0.05）。当在摘取肝脏前对移植器官进行15分钟的热缺血时，J组的胆汁生成减少（与N组相比，P < 0.05）；P组的胆汁生成得以恢复（与J组相比，P < 0.05）。在器官摘取前的数小时内，这种供体营养调节方法的临床应用可能会提高移植时肝移植器官的质量。
