Ghafaripour S, Sahmeddini M A, Lahsaee S M, Khosravi M B, Sattari H, Nikeghbalian S, Shokrizadeh S, Malekhosseine S A
Shiraz Organ Transplantation Center, Shiraz Medical University, Shiraz, Iran.
Prog Transplant. 2010 Sep;20(3):256-61. doi: 10.1177/152692481002000309.
The greatest hemodynamic instability during orthotopic liver transplantation occurs at graft reperfusion. Many factors have been implicated.
To compare hemodynamic changes after reperfusion in grafted livers preserved with histidine-tryptophan-ketoglutarate (HTK) solution versus grafted livers preserved with University of Wisconsin (UW) solution.
In this prospective study, we randomly divided 89 patients who underwent deceased donor liver transplantation into 2 groups: the UW group and the HTK group. The HTK group was further divided into 2 subgroups: flushed and not flushed before reperfusion. The patients were monitored with hemodynamic and metabolic parameters at 3 times: after the skin incision, 5 minutes before reperfusion, and 5 minutes after reperfusion.
Hemodynamic parameters in the UW group had not changed significantly at 5 minutes before reperfusion or 5 minutes after reperfusion (P = .45), and the incidence of hypotension after reperfusion in the UW group was 20%. In both HTK groups, the mean arterial pressure 5 minutes after reperfusion was significantly lower than at 5 minutes before reperfusion (P = .002); the incidence of hypotension after reperfusion in the nonflushed HTK group was 83.3% and in the flushed HTK group, 65.5%.
The incidence of hypotension after reperfusion is greater if HTK solution rather than UW solution is used. Flushing of grafted livers preserved with HTK solution might eliminate some vasoactive substances found in HTK solution.
原位肝移植过程中最大的血流动力学不稳定发生在移植物再灌注时。许多因素与之相关。
比较用组氨酸-色氨酸-酮戊二酸（HTK）溶液保存的移植肝与用威斯康星大学（UW）溶液保存的移植肝再灌注后的血流动力学变化。
在这项前瞻性研究中，我们将89例行尸体供肝移植的患者随机分为2组：UW组和HTK组。HTK组进一步分为2个亚组：再灌注前冲洗组和未冲洗组。在3个时间点对患者进行血流动力学和代谢参数监测：皮肤切开后、再灌注前5分钟和再灌注后5分钟。
UW组在再灌注前5分钟或再灌注后5分钟血流动力学参数无显著变化（P = 0.45），UW组再灌注后低血压发生率为20%。在两个HTK组中，再灌注后5分钟的平均动脉压均显著低于再灌注前5分钟（P = 0.002）；未冲洗HTK组再灌注后低血压发生率为83.3%，冲洗HTK组为65.5%。
使用HTK溶液而非UW溶液时，再灌注后低血压的发生率更高。用HTK溶液保存的移植肝冲洗可能会清除HTK溶液中发现的一些血管活性物质。
