Treckmann Jürgen, Minor Thomas, Saad Stefano, Ozcelik Arzu, Malagó Massimo, Broelsch Christoph Erich, Paul Andreas
Clinic for General, Visceral, and Transplantation Surgery, University Hospital of Essen, Essen, Germany.
Liver Transpl. 2008 Mar;14(3):358-64. doi: 10.1002/lt.21373.
Retrograde oxygen persufflation as a supplement of cold storage during the preservation period has the potential to better utilize ischemically damaged marginal livers in the experimental setting. Retrograde oxygen persufflation was applied in selected livers to demonstrate feasibility in the clinical setting and to investigate potential beneficial effects. Between 4/04 and 3/05 5 marginal otherwise discarded livers with warm ischemic damages from deceased donors (age 52 [37-64]) were accepted for transplantation. All organs were distantly procured and shipped to our center. Immediately after arrival, filtered humidified gaseous oxygen was given via the hepatic veins for at least 60 minutes with a pressure up to 18 mm mercury. Liver biopsies were analyzed for ATP content before and after persufflation. All patients (age 55 [46-66]) survived without retransplantation, had good initial function and are alive and well after minimum follow-up of two years. Bleeding from pinpricks stopped spontaneously after 5-10 minutes after reperfusion but was prolonged in one patient with severe coagulopathy until correction. One patient developed arterial thrombosis at postop day 0. He fully recovered after thrombectomy. Another patient developed subcapsular hematoma, which was removed at postop day 10. On routine postoperative biopsies vascular structures appeared undamaged. ATP levels in pre-reperfusion biopsies revealed a more than twofold increase of ATP content compared to biopsies before persufflation. Retrograde oxygen persufflation preservation is feasible and save in the clinical setting, improves early aerobic metabolism and therefore potentially improves primary organ function after liver transplantation.
在保存期内，逆行充氧作为冷保存的补充手段，有可能在实验环境中更好地利用缺血性损伤的边缘供肝。对选定的肝脏应用逆行充氧，以证明其在临床环境中的可行性，并研究潜在的有益效果。在2004年4月至2005年3月期间，接受了5例来自脑死亡供者（年龄52岁[37 - 64岁]）、伴有热缺血损伤的边缘供肝进行移植。所有器官均远距离获取并运至我们中心。到达后立即经肝静脉给予过滤加湿的气态氧至少60分钟，压力高达18毫米汞柱。对充氧前后的肝组织活检标本进行ATP含量分析。所有患者（年龄55岁[46 - 66岁]）均存活且未进行再次移植，初始肝功能良好，在最短两年的随访后仍存活且状况良好。再灌注后5 - 10分钟，针刺出血自行停止，但1例患有严重凝血功能障碍的患者出血时间延长，直至凝血功能得到纠正。1例患者在术后第0天发生动脉血栓形成，血栓切除术后完全康复。另1例患者出现包膜下血肿，在术后第10天进行了清除。术后常规活检显示血管结构未受损。与充氧前的活检标本相比，再灌注前活检标本中的ATP水平显示ATP含量增加了两倍多。逆行充氧保存在临床环境中是可行且安全的，可改善早期有氧代谢，因此可能改善肝移植后的原发性器官功能。
