Department of Surgery, Faculty of Medicine, Rheinische Friedrich-Wilhelms-Universität, Sigmund-Freudstr. 25, 53127, Bonn, Germany.
Department of Radiotherapy and Radiation Oncology, Faculty of Medicine, Heinrich-Heine-Universität, Düsseldorf, Germany.
Eur J Med Res. 2018 Oct 23;23(1):51. doi: 10.1186/s40001-018-0346-5.
The ever growing demand for liver transplantation inevitably necessitates an expansion of the donor pool. Utilization of "shock organs" is considered suboptimal to date while the associated outcome has hardly been investigated.
Male Wistar rats underwent a period of 30 min of hypovolemic shock. After 24 h livers were explanted and prior to reperfusion underwent either 18 h of cold storage (CS; N = 6) or 17 h of CS followed by 60 min venous systemic oxygen persufflation (VSOP; N = 6). The outcome of "shock organs (SHBD)" was compared to heart-beating donor (HBD; N = 12) as positive control and non-heart-beating donor (NHBD; N = 12) as negative control animal groups. Liver function was assessed by measuring enzyme release (AST, ALT, LDH), bile production, portal vein pressure and hepatic oxygen uptake during reperfusion. For reperfusion, the isolated perfused rat liver system was used.
Liver function was severely limited in NHBD group compared to HBD organs after 18 h of CS (e.g., AST; HBD: 32.25 ± 7.25 U/l vs. NHBD: 790 ± 414.56 U/l; p < 0.005). VSOP improved liver function of NHBD organs significantly (AST; NHBD + VSOP: 333.6 ± 149.1 U/l; p < 0.005). SHBD organs showed a comparable outcome to HBD and clearly better results than NHBD organs after 18 h of CS (AST; SHBD: 76.4 ± 21.9 U/l). After 17 h of CS accompanied by 60 min VSOP, no improvement concerning liver function and integrity of SHBD organs was observed while the results were severely deteriorated by VSOP resulting in higher enzyme release (AST; SHBD + VSOP: 213 ± 61 U/l, p < 0.001), higher portal vein pressure (SHBD: 10.8 ± 1.92 mm Hg vs. SHBD + VSOP: 21.6 ± 8.8 mm Hg; p < 0.05) and lower hepatic oxygen uptake (SHBD: 321.75 ± 3.87 ml/glw/min vs. SHBD + VSOP: 395.8 ± 46.64 ml/glw/min, p < 0.05) at 24 h.
Our data suggest that the potential of "shock organs" within liver transplantation may be underestimated. If our findings are reproducable in humans, SHBD grafts should be considered as a valuable source for expanding the thus far limited donor pool.
随着对肝移植需求的不断增长，不可避免地需要扩大供体库。迄今为止，利用“休克器官”被认为是不理想的，而相关的结果几乎没有被研究过。
雄性 Wistar 大鼠经历了 30 分钟的低血容量性休克。24 小时后，取出肝脏，在再灌注前进行 18 小时的冷保存（CS；N=6）或 17 小时 CS 后进行 60 分钟静脉全身氧灌注（VSOP；N=6）。“休克器官（SHBD）”的结果与心脏跳动供体（HBD；N=12）作为阳性对照和非心脏跳动供体（NHBD；N=12）作为阴性对照动物组进行比较。通过测量酶释放（AST、ALT、LDH）、胆汁生成、门静脉压力和再灌注期间的肝氧摄取来评估肝功能。再灌注时，使用离体灌注大鼠肝系统。
与 HBD 器官相比，NHBD 组在 18 小时 CS 后肝功能严重受限（例如，AST；HBD：32.25±7.25 U/l 与 NHBD：790±414.56 U/l；p<0.005）。VSOP 显著改善了 NHBD 器官的肝功能（AST；NHBD+VSOP：333.6±149.1 U/l；p<0.005）。SHBD 器官在 18 小时 CS 后与 HBD 和 NHBD 器官的结果相当，但明显优于 NHBD 器官（AST；SHBD：76.4±21.9 U/l）。在 17 小时 CS 后进行 60 分钟 VSOP 时，SHBD 器官的肝功能和完整性没有改善，而 VSOP 导致的酶释放增加（AST；SHBD+VSOP：213±61 U/l，p<0.001）、门静脉压力升高（SHBD：10.8±1.92 mm Hg 与 SHBD+VSOP：21.6±8.8 mm Hg；p<0.05）和肝氧摄取降低（SHBD：321.75±3.87 ml/glw/min 与 SHBD+VSOP：395.8±46.64 ml/glw/min，p<0.05），在 24 小时时更严重。
我们的数据表明，肝移植中“休克器官”的潜力可能被低估了。如果我们的发现在人类中具有重现性，那么 SHBD 移植物应该被视为扩大迄今为止有限的供体库的有价值来源。
