Florack G, Sutherland D E, Ascherl R, Heil J, Erhardt W, Najarian J S
J Surg Res. 1986 Jun;40(6):550-63. doi: 10.1016/0022-4804(86)90097-1.
Normothermic ischemia tolerance is an important aspect of organ procurement and transplantation. The function of pancreas and kidney autografts was investigated in totally pancreatectomized or nephrectomized canine recipients. In 30 dogs the left limb (tail) of the pancreas was removed but left in the abdominal cavity after cessation of blood flow to produce warm ischemia for 30, 60, and 120 min (10 dogs at each time point), and then was flushed with cold Ringers' lactate and transplanted to the iliac vessels. Twenty dogs with fresh pancreatic transplants were controls. The success rate of pancreas transplants with warm ischemia of 1/2 and 1 hr was the same as that of controls (80%); however, after 1 hr normothermia 5/10 dogs had episodes of hyperglycemia for 1 week before glucose levels came back to normal. All but one graft with 2 hr warm ischemia failed. Intravenous glucose tolerance test (IVGTT) mean (+/- SEM) K values were not different in the successful groups, i.e., no warm ischemia: -1.55 +/- 0.15%; 1/2 hr warm ischemia: -1.81 +/- 0.18%; 1 hr warm ischemia: -1.64 +/- 0.09%. Amylase levels increased after transplant with maximum values at Day 2, then returned to normal, but the levels remained elevated in recipients of grafts subjected to longer normothermia with evidence of pancreatitis after 1 hr warm ischemia. Fifteen kidney grafts were treated similarly with warm ischemia exposure of 1/2 hr (n = 9) and 1 hr (n = 6) before being flushed and autotransplanted, and were compared to 16 fresh kidney transplants. After 1/2 hr warm ischemia none of the kidney grafts failed but 78% of the recipients had elevated serum creatinine and urea nitrogen levels which returned slowly to normal after 3 to 4 weeks. There was only one long-term survivor after 1 hr warm ischemia. Thus the pancreas seems to be more resistant to warm ischemia damage than is the kidney. This difference should be taken into consideration in regard to organ procurement for clinical transplantation.
常温缺血耐受性是器官获取与移植的一个重要方面。在全胰切除或肾切除的犬类受体中研究了胰腺和肾脏自体移植的功能。在30只狗中，切除胰腺的左肢（尾部），但在血流停止后留在腹腔内，造成30、60和120分钟的热缺血（每个时间点10只狗），然后用冷乳酸林格氏液冲洗并移植到髂血管。20只接受新鲜胰腺移植的狗作为对照。热缺血1/2小时和1小时的胰腺移植成功率与对照组相同（80%）；然而，常温1小时后，5/10的狗在血糖水平恢复正常前有1周的高血糖发作。热缺血2小时的移植除1例成功外均失败。成功组静脉葡萄糖耐量试验（IVGTT）的平均（±标准误）K值无差异，即无热缺血：-1.55±0.15%；热缺血1/2小时：-1.81±0.18%；热缺血1小时：-1.64±0.09%。移植后淀粉酶水平升高，在第2天达到最大值，然后恢复正常，但在热缺血1小时后经历较长时间常温且有胰腺炎证据的移植受体中，淀粉酶水平仍保持升高。15个肾脏移植在冲洗和自体移植前同样进行了1/2小时（n = 9）和1小时（n = 6）的热缺血处理，并与16个新鲜肾脏移植进行比较。热缺血1/2小时后，没有肾脏移植失败，但78%的受体血清肌酐和尿素氮水平升高，3至4周后缓慢恢复正常。热缺血1小时后只有1例长期存活者。因此，胰腺似乎比肾脏对热缺血损伤更具抵抗力。在临床移植的器官获取方面应考虑到这种差异。
