Homvises B, Sirivatanauksorn Y, Limsrichamrern S, Pongraweewan O, Sujirattanawimol K, Raksakietisak M
Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Transplant Proc. 2008 Sep;40(7):2123-6. doi: 10.1016/j.transproceed.2008.06.035.
Organ preservation is one of the important steps that predicts the patient outcome. However, after revascularization, the high concentration of potassium that influxes into the circulation might cause immediate postreperfusion hyperkalemia. To prevent this complication, the portal vein has been washed out with flush fluid to remove preservation fluid before reperfusion. Up to now, it has not been established what exact amount volume of albumin provides washout of the UW solution.
Eleven of 20 patients who underwent orthotopic liver transplantation (OLT) between December, 2003, and June, 2005, were enrolled in this study. OLT was performed following the standard technique. Five percent albumin (1000 mL) was flushed through the portal vein canula before reperfusion of the donor liver. Every 100 mL of flush fluid effluent was collected from an incomplete infrahepatic inferior vena cava anastomosis for electrolyte measurement. The 10 flushed fluid samples were measured for potassium concentration. Mean arterial pressure was monitored preoperatively, at 1-minute intervals after reperfusion and at 60 minutes after reperfusion.
We observed that 61.5% of potassium was removed after only 100 mL of flush fluid, and 90.8% after 500 mL. Only one patient in this study had an effluent potassium reduction that did not achieved 90% after 500- or 1000-mL flush. However, this patient did not develop either postreperfusion syndrome or hyperkalemia. One patient did experience postreperfusion hyperkalemia (6.20 mEq) with severe hypothermia and cardiac arrest. Five patients had stable hemodynamic profiles and five patients, transient, reversible hypotension without postreperfusion hyperkalemia.
We propose that the minimal flush volume for washout of preservation fluid in liver transplantation is 500 mL, to reduce the risk of postreperfusion syndrome and hyperkalemia.
器官保存是预测患者预后的重要步骤之一。然而，血管再通后，流入循环系统的高浓度钾可能导致再灌注后即刻高钾血症。为预防这一并发症，在再灌注前用冲洗液冲洗门静脉以清除保存液。到目前为止，尚未确定确切需要多少体积的白蛋白才能冲洗掉UW溶液。
选取2003年12月至2005年6月期间接受原位肝移植（OLT）的20例患者中的11例纳入本研究。OLT按照标准技术进行。在供肝再灌注前，通过门静脉插管注入5%白蛋白（1000 mL）。从肝下下腔静脉吻合口不完全处每收集100 mL冲洗液流出物用于电解质测量。对10份冲洗液样本进行钾浓度测定。术前、再灌注后1分钟间隔以及再灌注后60分钟监测平均动脉压。
我们观察到仅100 mL冲洗液后61.5%的钾被清除，500 mL后90.8%的钾被清除。本研究中只有1例患者在冲洗500 mL或1000 mL后流出液钾减少未达到90%。然而，该患者未发生再灌注综合征或高钾血症。1例患者出现再灌注后高钾血症（6.20 mEq），伴有严重体温过低和心脏骤停。5例患者血流动力学稳定，5例患者出现短暂、可逆性低血压，未发生再灌注后高钾血症。
我们建议肝移植中冲洗保存液的最小冲洗量为500 mL，以降低再灌注综合征和高钾血症的风险。
