肝移植中组氨酸 - 色氨酸 - 酮戊二酸联合冲洗液与威斯康星大学保存液的应用：初步结果

Combined Flush With Histidine-Tryptophan-Ketoglutarate and University of Wisconsin Solutions in Liver Transplantation: Preliminary Results.

作者信息

León Díaz F J, Fernández Aguilar J L, Nicolás de Cabo S, Pérez Reyes M, Sánchez Pérez B, Montiel Casado C, Pérez Daga J A, Aranda Narváez J M, Suárez Muñoz M A, Arenas González F, Florez Rías M M, Pelaez Angulo J L, Santoyo Santoyo J

机构信息

Faculty of Medicine, University of Malaga, Malaga, Spain; Department of Surgery, Liver Transplant Unit, Regional Hospital, Málaga, Spain.

出版信息

Transplant Proc. 2018 Mar;50(2):539-542. doi: 10.1016/j.transproceed.2017.12.033.

DOI:10.1016/j.transproceed.2017.12.033

PMID:29579846

Abstract

INTRODUCTION

Ischemia reperfusion injury (IRI) is the main cause of early allograft dysfunction (EAD) and subsequent primary allograft failure (PAF).

OBJECTIVES

The purpose of this study is to compare IRI, EAD, and PAF in liver transplantation in a cohort of patients perfused with histidine-tryptophan-ketoglutarate (HTK) solution and University of Wisconsin (UW) solution versus HTK alone.

METHODS

A randomized trial was performed to compare outcomes in liver recipients who underwent transplantation surgery in the University Regional Hospital of Malaga, Spain. Forty patients were randomized to two groups. Primary endpoints included IRI, EAD, PAF, re-intervention, acute cellular rejection, retransplantation, arterial complications, and biliary complications at postoperative day 90.

RESULTS

Postoperative glutamic oxaloacetic transaminase (1869.15 ± 1559.75 UI/L vs. 953.15 ± 777.27 UI/L; P = .004) and glutamic pyruvic transaminase (1333.60 ± 1115.49 U/L vs. 721.70 ± 725.02 U/L; P = .023) were significantly higher in patients perfused with HTK alone. A clear tendency was observed in recipients perfused with HTK alone to present moderate to severe IRI (7 patients in the HTK + UW solution group vs. 15 patients in the HTK-alone solution group; P = .06), EAD (0 patients in the HTK + UW solution group vs. 0 patients in the HTK-alone solution group; P = .76), and PAF (3 patients in the HTK + UW solution group vs. 8 patients in the HTK-alone solution group; P = .15).

CONCLUSIONS

Initial perfusion with HTK solution followed by UW solution in liver transplantation improves early liver function as compared to perfusion with HTK alone.

摘要

引言

缺血再灌注损伤（IRI）是早期移植肝功能障碍（EAD）及随后原发性移植肝无功能（PAF）的主要原因。

目的

本研究旨在比较在一组接受组氨酸 - 色氨酸 - 酮戊二酸（HTK）溶液和威斯康星大学（UW）溶液灌注的患者与仅接受HTK溶液灌注的患者中，肝移植时的IRI、EAD和PAF情况。

方法

在西班牙马拉加大学区域医院进行了一项随机试验，比较接受肝移植手术的患者的结局。40例患者被随机分为两组。主要终点包括术后90天时的IRI、EAD、PAF、再次干预、急性细胞排斥反应、再次移植、动脉并发症和胆道并发症。

结果

仅接受HTK溶液灌注的患者术后谷草转氨酶（1869.15±1559.75 UI/L对953.15±777.27 UI/L；P = .004）和谷丙转氨酶（1333.60±1115.49 U/L对721.70±725.02 U/L；P = .023）显著更高。在仅接受HTK溶液灌注的受者中观察到出现中度至重度IRI（HTK + UW溶液组7例患者对仅HTK溶液组15例患者；P = .06）、EAD（HTK + UW溶液组0例患者对仅HTK溶液组0例患者；P = .76）和PAF（HTK + UW溶液组3例患者对仅HTK溶液组8例患者；P = .15）的明显趋势。