Department of Transplant Surgery, Jichi Medical University, Shimotsuke City, Tochigi, Japan.
J Surg Res. 2013 Apr;180(2):349-55. doi: 10.1016/j.jss.2012.05.004. Epub 2012 May 24.
Endotoxin (Et) in the portal vein blood is processed by the hepatic reticuloendothelial system. Thus, it is possible that the Et kinetics of the peripheral venous blood may be useful as a biological index that can be used to evaluate liver function. In this study, we measured Et using the endotoxin activity assay in peripheral venous blood during living donor liver transplantation (LDLT), to study its clinical significance.
Subjects were 17 patients who underwent LDLT. In the perioperative peripheral venous blood, was measured Et activity (EA) using the endotoxin activity assay at 1 or 2 d before LT, and then on 1, 5, 7, 14, and 21 postoperative days.
Patients with infections had significantly higher EA levels compared with those without complications before LDLT and 14 postoperative days (P = 0.038 and 0.027, respectively). The average EA level of patients with infections and without complications before LT was 0.22 and 0.08, respectively (P = 0.038). Patients with an EA level higher than 0.20 before LDLT had a significantly longer period of hospitalization compared with those without complications (P = 0.038).
A preoperative EA level more than 0.20 is a high risk factor for post-transplant infection and a prolonged period of hospitalization.
门静脉血液中的内毒素（Et）由肝脏网状内皮系统处理。因此，外周静脉血中的 Et 动力学可能是一种有用的生物指标，可以用于评估肝功能。在这项研究中，我们在活体肝移植（LDLT）期间通过外周静脉血中的内毒素活性测定来测量 Et，以研究其临床意义。
研究对象为 17 例行 LDLT 的患者。在围手术期外周静脉血中，在 LT 前 1 或 2 天以及术后第 1、5、7、14 和 21 天，使用内毒素活性测定法测量 Et 活性（EA）。
在 LDLT 前和术后第 14 天，有感染的患者的 EA 水平明显高于无并发症的患者（分别为 P = 0.038 和 0.027）。在 LT 前，有感染和无并发症的患者的平均 EA 水平分别为 0.22 和 0.08（P = 0.038）。在 LDLT 前 EA 水平高于 0.20 的患者与无并发症的患者相比，住院时间明显延长（P = 0.038）。
术前 EA 水平大于 0.20 是术后感染和延长住院时间的高危因素。
