Walcher F, Marzi I, Bühren V
Department of Surgery, University of Saarland, Homburg/Saar, Germany.
Transpl Int. 1992;5 Suppl 1:S340-2. doi: 10.1007/978-3-642-77423-2_104.
Severe microcirculatory disturbances due to endothelial cell damage and leukocyte adherence during reperfusion of transplanted livers are considered to contribute to early graft failure. Since the degree of reperfusion injury after liver transplantation depends on the length of preservation time and the solution used for preservation, the aim of our study was to assess three solutions with respect to microvascular perfusion and leukocyte adhesion. Therefore, rat livers were stored up to 24 h in Euro-Collins (EC), University of Wisconsin (UW), or histidin-tryphtophan-ketoglutarate (HTK) solutions prior to orthotopic transplantation. The livers were studied in situ 60 min postoperatively using intravital fluorescence video microscopy. Using simple syringe flushing (10 ml), sinusoidal perfusion decreased below 50% in EC preserved livers after 8 h preservation, in HTK preserved livers after 16 h preservation, and remained higher than 70% in livers preserved in UW up to 24 h. Permanent adhesion of leukocytes was increased more rapidly in organs after 1, 8, 16, and 24 h preservation in HTK (16%, 15%, 34%, and 49.7% +/- 4.7%) compared to those preserved in UW (15%, 18%, 17%; and 32.7% +/- 3.3%; P<0.05). Using a 10-fold volumn of the organ weight of HTK solution during the harvesting procedure, with an 8 min equilibration period, sinusoidal perfusion (39.6 +/- 4.7%) and leukocyte adhesion (42.7 +/- 3.1%) were not improved after 24 h. In contrast, equilibration with a volumn of approximately 40-times the liver weight improved sinusoidal perfusion (70.8% +/- 2.7%; P < 0.01) and leukocyte adhesion (24.9% +/- 3.1%; P < 0.01) significantly. Thus, using HTK solution, simple flushing prior to long-term cold storage resulted in microcirculatory disturbances when compared to UW solution. Larger volumns of HTK solution with an additional equilibration period of 8 min, however, reduced leukocyte adhesion and improved sinusoidal perfusion to a similar degree as UW solution.
移植肝脏再灌注期间，由于内皮细胞损伤和白细胞黏附导致的严重微循环紊乱被认为是早期移植物功能衰竭的原因之一。由于肝移植后再灌注损伤的程度取决于保存时间的长短以及用于保存的溶液，我们研究的目的是评估三种溶液对微血管灌注和白细胞黏附的影响。因此，在原位肝移植前，将大鼠肝脏分别置于欧洲柯林斯（EC）液、威斯康星大学（UW）液或组氨酸-色氨酸-酮戊二酸（HTK）液中保存长达24小时。术后60分钟使用活体荧光视频显微镜对肝脏进行原位研究。通过简单的注射器冲洗（10毫升），保存8小时后，EC液保存的肝脏肝血窦灌注降至50%以下；保存16小时后，HTK液保存的肝脏肝血窦灌注降至50%以下；而UW液保存的肝脏在长达24小时的保存时间内肝血窦灌注仍高于70%。与UW液保存的器官（15%、18%、17%和32.7%±3.3%；P<0.05）相比，HTK液保存1、8、16和24小时后的器官中白细胞的永久黏附增加得更快（分别为16%、15%、34%和49.7%±4.7%）。在获取过程中使用10倍肝脏重量体积的HTK液，并平衡8分钟，24小时后肝血窦灌注（39.6±4.7%）和白细胞黏附（42.7±3.1%）并未得到改善。相比之下，用大约40倍肝脏重量体积的溶液平衡显著改善了肝血窦灌注（70.8%±2.7%；P<0.01）和白细胞黏附（24.9%±3.1%；P<0.01）。因此，与UW液相比，使用HTK液在长期冷藏前进行简单冲洗会导致微循环紊乱。然而，使用更大体积的HTK液并额外平衡8分钟，可使白细胞黏附减少，肝血窦灌注改善至与UW液相似的程度。
