Okada N, Sanada Y, Urahashi T, Ihara Y, Yamada N, Hirata Y, Katano T, Otomo S, Ushijima K, Mizuta K
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
Department of Transplant Surgery, Jichi Medical University, Tochigi, Japan.
Transplant Proc. 2018 Jun;50(5):1360-1364. doi: 10.1016/j.transproceed.2018.01.052. Epub 2018 Apr 25.
The hepatic clearance of endotoxin (Et) may reflect hepatic functional reserve and ischemic injury to hepatocytes. Therefore, we examined the relationships between Et activity (EA) and the metrics Pediatric End-Stage Liver Disease (PELD)/Model of End-Stage Liver Disease (MELD) score and alanine transaminase (ALT) levels in the postoperative period.
We performed 8 living-donor liver transplantations (LDLTs) for biliary atresia at our center from April 2012 to December 2012. EA was measured by means of an Et activity assay (EAA) in samples collected from a vein 1 day before LDLT, from the portal vein during the intraoperative anhepatic phase, from an artery 1 hour after reperfusion, from an artery on postoperative day (POD) 1, and from an artery or vein at PODs 7 and 14.
EAs generally remained at low levels. EA at the reperfusion period was significantly lowest. The correlation coefficient for the preoperative MELD/PELD score and the EAA was 0.837, and the corresponding P value was .009; thus, there was a significant relationship between the preoperative MELD/PELD score and the EAA. The correlation coefficients for ALT at POD 1 and EA during the anhepatic phase, at 1 hour after reperfusion, and at POD 1 were 0.64, 0.43, and 0.38, respectively, and the P values for these correlations were .08, .67, and .34. Thus, we observed that ALT and EA generally tended to be somewhat directly correlated, but no significant relationships between these 2 metrics were observed.
Endotoxin metabolism reflects the hepatic functional reserve capacity of end-stage liver disease.
内毒素（Et）的肝脏清除率可能反映肝脏功能储备和肝细胞缺血损伤。因此，我们研究了术后内毒素活性（EA）与小儿终末期肝病（PELD）/终末期肝病模型（MELD）评分以及丙氨酸转氨酶（ALT）水平之间的关系。
2012年4月至2012年12月，我们中心对8例因胆道闭锁接受活体肝移植（LDLT）的患者进行了研究。通过内毒素活性测定（EAA）在以下时间点采集的样本中测量EA：肝移植术前1天从静脉采集；术中无肝期从门静脉采集；再灌注后1小时从动脉采集；术后第1天（POD）从动脉采集；术后第7天和第14天从动脉或静脉采集。
EA一般维持在较低水平。再灌注期的EA显著最低。术前MELD/PELD评分与EAA的相关系数为0.837，相应P值为.009；因此，术前MELD/PELD评分与EAA之间存在显著关系。术后第1天ALT与无肝期、再灌注后1小时及术后第1天EA的相关系数分别为0.64、0.43和0.38，这些相关性的P值分别为.08、.67和.34。因此，我们观察到ALT和EA总体上倾向于呈某种直接相关，但未观察到这两个指标之间存在显著关系。
内毒素代谢反映了终末期肝病的肝脏功能储备能力。
