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肝移植中移植物保存液对早期细胞因子释放及术后器官功能障碍的影响。一项初步研究。

Impact of graft preservation solutions for liver transplantation on early cytokine release and postoperative organ dysfunctions. A pilot study.

作者信息

Brisson H, Arbelot C, Monsel A, Parisot C, Girard M, Savier E, Vezinet C, Lu Q, Vaillant J-C, Golmard J-L, Gorochov G, Langeron O, Rouby J-J

机构信息

Department of Anesthesiology and Critical Care Medicine, Multidisciplinary Intensive Care Unit, AP-HP, La Pitié-Salpêtrière Hospital, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France(1); UMR-S 945, La Pitié-Salpêtrière Hospital, Institut national de la santé et de la recherche médicale, AP-HP, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France.

Department of Anesthesiology and Critical Care Medicine, Multidisciplinary Intensive Care Unit, AP-HP, La Pitié-Salpêtrière Hospital, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France(1).

出版信息

Clin Res Hepatol Gastroenterol. 2017 Oct;41(5):564-574. doi: 10.1016/j.clinre.2016.12.011. Epub 2017 Mar 18.

Abstract

INTRODUCTION

During liver transplantation, graft ischemia-reperfusion injury leads to a systemic inflammatory response producing postoperative organ dysfunctions. The aim of this observational and prospective study was to compare the impact of Solution de conservation des organes et tissus (SCOT) 15 and University of Wisconsin (UW) preservation solutions on early cytokine release, postreperfusion syndrome and postoperative organ dysfunctions.

METHODS

Thirty-seven liver transplantations were included: 21 in UW Group and 16 in SCOT 15 group. Five cytokines were measured in systemic blood after anesthetic induction, 30minutes after unclamping portal vein and on postoperative day 1.

RESULTS

Following unclamping portal vein, cytokines were released in systemic circulation. Systemic cytokine concentrations were higher in UW than in SCOT 15 group: Interleukin-10, Interleukine-6. In SCOT 15 group, significant reduction of postreperfusion syndrome incidence and acute kidney injury were observed. Alanine and aspartate aminotransferase peak concentrations were higher in SCOT 15 group than in UW group. However, from postoperative day 1 to day 10, aminotransferase returned to normal values and did not differ between groups.

CONCLUSIONS

Compared to UW, SCOT 15 decreases systemic cytokine release resulting from graft ischemia-reperfusion injury and reduces incidence of postreperfusion syndrome and postoperative renal failure.

摘要

引言

在肝移植过程中,移植物缺血再灌注损伤会引发全身炎症反应,导致术后器官功能障碍。这项观察性前瞻性研究的目的是比较器官和组织保存液(SCOT)15与威斯康星大学(UW)保存液对早期细胞因子释放、再灌注后综合征及术后器官功能障碍的影响。

方法

纳入37例肝移植手术:UW组21例,SCOT 15组16例。在麻醉诱导后、门静脉开放30分钟及术后第1天,检测外周血中的5种细胞因子。

结果

门静脉开放后,细胞因子释放入全身循环。UW组全身细胞因子浓度高于SCOT 15组:白细胞介素-10、白细胞介素-6。在SCOT 15组,观察到再灌注后综合征发生率及急性肾损伤显著降低。SCOT 15组丙氨酸和天冬氨酸转氨酶峰值浓度高于UW组。然而,从术后第1天至第10天,转氨酶恢复至正常水平,两组间无差异。

结论

与UW相比,SCOT 15可减少移植物缺血再灌注损伤导致的全身细胞因子释放,并降低再灌注后综合征及术后肾衰竭的发生率。

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