Schiefer Judith, Lebherz-Eichinger Diana, Erdoes Gabor, Berlakovich Gabriela, Bacher Andreas, Krenn Claus G, Faybik Peter
1 Department of Anesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria. 2 Division of Transplantation, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Transplantation. 2015 Oct;99(10):2118-23. doi: 10.1097/TP.0000000000000680.
Endothelial glycocalyx participates in the maintenance of vascular integrity, and its perturbations cause capillary leakage, loss of vascular responsiveness, and enhanced adhesion of leukocytes and platelets. We hypothesized that marked shedding of the glycocalyx core protein, syndecan-1, occurs in end-stage liver disease (ESLD) and that it increases during orthotopic liver transplantation (OLT). We further evaluated the effects of general anesthesia on glycocalyx shedding and its association with acute kidney injury (AKI) after OLT.
Thirty consecutive liver transplant recipients were enrolled in this prospective study. Ten healthy volunteers served as a control. Acute kidney injury was defined by Acute Kidney Injury Network criteria.
Plasma syndecan-1 was significantly higher in ESLD patients than in healthy volunteers (74.3 ± 59.9 vs 10.7 ± 9.4 ng/mL), and it further increased significantly after reperfusion (74.3 ± 59.9 vs 312.6 ± 114.8 ng/mL). The type of general anesthesia had no significant effect on syndecan-1. Syndecan-1 was significantly higher during the entire study in patients with posttransplant AKI stage 2 or 3 compared to patients with AKI stage 0 or 1. The area under the curve of the receiver operating characteristics curve of syndecane-1 to predict AKI stage 2 or 3 within 48 hours after reperfusion was 0.76 (95% confidence interval, 0.57-0.89, P = 0.005).
Patients with ESLD suffer from glycocalyx alterations, and ischemia-reperfusion injury during OLT further exacerbates its damage. Despite a higher incidence of AKI in patients with elevated syndecan-1, it is not helpful to predict de novo AKI. Volatile anesthetics did not attenuate glycocalyx shedding in human OLT.
内皮糖萼参与维持血管完整性，其受损会导致毛细血管渗漏、血管反应性丧失以及白细胞和血小板黏附增强。我们推测，在终末期肝病（ESLD）中糖萼核心蛋白syndecan-1会显著脱落，且在原位肝移植（OLT）过程中会增加。我们进一步评估了全身麻醉对糖萼脱落的影响及其与OLT后急性肾损伤（AKI）的关系。
30例连续的肝移植受者纳入了这项前瞻性研究。10名健康志愿者作为对照。急性肾损伤根据急性肾损伤网络标准定义。
ESLD患者血浆syndecan-1显著高于健康志愿者（74.3±59.9对10.7±9.4 ng/mL），再灌注后进一步显著升高（74.3±59.9对312.6±114.8 ng/mL）。全身麻醉类型对syndecan-1无显著影响。与AKI 0期或1期患者相比，移植后AKI 2期或3期患者在整个研究期间syndecan-1显著更高。syndecan-1预测再灌注后48小时内AKI 2期或3期的受试者工作特征曲线下面积为0.76（95%置信区间，0.57 - 0.89，P = 0.005）。
ESLD患者存在糖萼改变，OLT期间的缺血再灌注损伤会进一步加重其损害。尽管syndecan-1升高的患者AKI发生率较高，但它对预测新发AKI并无帮助。挥发性麻醉药并未减轻人OLT中糖萼的脱落。
