Tsai Y-F, Liu F-C, Sung W-C, Lin C-C, Chung P C-H, Lee W-C, Yu H-P
Department of Anesthesiology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao-Yuan, Taiwan.
Department of Anesthesiology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan.
Transplant Proc. 2014 May;46(4):1082-6. doi: 10.1016/j.transproceed.2014.01.009.
Liver ischemic reperfusion injury is harmful to transplant recipients, and is associated with postoperative morbidity and mortality. Our study was designed to investigate the oxidative stress and pro-inflammatory mediators in liver transplant recipients.
We prospectively analyzed 14 recipients who underwent liver transplantation by measuring their blood levels of malondialdehyde (MDA) and cytokines, such as tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and IL-6, at nine time points perioperatively. We also evaluated the correlations between oxidative stress (MDA levels) and the characteristics of the recipient or the donated graft.
These parameters significantly increased from 1 minute before reperfusion, and the values peaked within 3 to 30 minutes after reperfusion. On the time point at 5 minutes after reperfusion, the MDA levels which were the highest in the recipients correlated with the values of preoperative direct/and total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), model for end-stage liver disease (MELD) score, international normalized ratio (INR), and surgical blood loss.
The levels of MDA, TNF-α, IL-1β, and IL-6 greatly increased with the ischemic reperfusion insult. Recipients with higher values of preoperative direct/and total bilirubin, AST, ALT, MELD score, INR, and surgical blood loss tended to have higher levels of MDA and may suffer more injury from this insult.
肝缺血再灌注损伤对移植受者有害，且与术后发病率和死亡率相关。我们的研究旨在调查肝移植受者中的氧化应激和促炎介质。
我们前瞻性地分析了14例接受肝移植的受者，在围手术期的9个时间点测量他们血液中的丙二醛（MDA）水平以及细胞因子，如肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）和IL-6。我们还评估了氧化应激（MDA水平）与受者或捐赠移植物特征之间的相关性。
这些参数从再灌注前1分钟开始显著升高，且在再灌注后3至30分钟内达到峰值。在再灌注后5分钟的时间点，受者中最高的MDA水平与术前直接胆红素/总胆红素、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、终末期肝病模型（MELD）评分、国际标准化比值（INR）以及手术失血量的值相关。
MDA、TNF-α、IL-1β和IL-6的水平随着缺血再灌注损伤而大幅升高。术前直接胆红素/总胆红素、AST、ALT、MELD评分、INR以及手术失血量较高的受者往往MDA水平较高，可能因这种损伤而遭受更多伤害。
