Wahlin Staffan, Srikanthan Nirthiga, Hamre Børge, Harper Pauline, Brun Atle
Department of Gastroenterology and Hepatology, Porphyria Centre Sweden, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Liver Transpl. 2008 Sep;14(9):1340-6. doi: 10.1002/lt.21527.
Erythropoietic protoporphyria is an inherited condition characterized by pronounced solar photosensitivity and in a minority of patients severe liver disease that necessitates liver transplantation for survival. Phototoxic injury to abdominal organs and skin has been reported in several cases of liver transplantation surgery, including a few transplants in which protective light filters were used. This study discusses the optimal characteristics of light filters used during liver transplantation surgery. An experimental model is used to evaluate the relative protection of different filters, and the results are compared with theoretical calculations regarding the risk for phototoxic injury from light sources in health-care procedures. Whether protective measures are warranted in other illuminated procedures besides liver transplantation has been discussed often but never studied. This study elucidates the risk for phototoxic injury in endoscopy, laparoscopy, and non-liver transplant surgery. A theoretical model and epidemiological data are considered. Our findings indicate that endoscopy, laparoscopy, and surgical procedures other than liver transplantation are safe in the noncholestatic protoporphyria patient and that general recommendations for using filters in these situations are not warranted. Among the tested filters, a flexible yellow filter omitting wavelengths below 470 nm is recommended for liver transplant surgery. This filter has been readily accepted by surgeons and offers a good balance between protection and altered visual color perception. The experimental model, using hemolysis of protoporphyrin-loaded erythrocytes as a measure of phototoxicity, has substantiated theoretical findings on relative filter protection.
红细胞生成性原卟啉病是一种遗传性疾病，其特征为对日光有明显的光敏性，少数患者会出现严重的肝脏疾病，需要进行肝移植才能存活。在几例肝移植手术中，包括一些使用了防护滤光器的移植手术，都报告了腹部器官和皮肤的光毒性损伤。本研究讨论了肝移植手术中使用的滤光器的最佳特性。使用一个实验模型来评估不同滤光器的相对防护效果，并将结果与关于医疗程序中光源导致光毒性损伤风险的理论计算进行比较。除肝移植外，其他光照程序是否需要采取防护措施经常被讨论，但从未进行过研究。本研究阐明了在内镜检查、腹腔镜检查和非肝移植手术中的光毒性损伤风险。考虑了一个理论模型和流行病学数据。我们的研究结果表明，对于非胆汁淤积性原卟啉病患者，内镜检查、腹腔镜检查和非肝移植手术是安全的，在这些情况下使用滤光器的一般建议是不必要的。在测试的滤光器中，推荐在肝移植手术中使用一种能滤除波长低于470nm光的柔性黄色滤光器。这种滤光器已被外科医生欣然接受，并且在防护和视觉颜色感知改变之间提供了良好的平衡。以加载原卟啉的红细胞溶血作为光毒性衡量指标的实验模型，证实了关于滤光器相对防护效果的理论发现。
