Reydellet Laurent, Le Saux Audrey, Blasco Valery, Nafati Cyril, Harti-Souab Karim, Armand Romain, Lannelongue Ariane, Gregoire Emilie, Hardwigsen Jean, Albanese Jacques, Chopinet Sophie
Department of Anaesthesia and Intensive Care, Hôpital la Timone, 13005 Marseille, France.
Department of Anaesthesia and Intensive Care, Carémeau Hospital, 30029 Nîmes, France.
J Clin Med. 2023 Apr 18;12(8):2940. doi: 10.3390/jcm12082940.
Hyperoxia is common during liver transplantation (LT), without being supported by any guidelines. Recent studies have shown the potential deleterious effect of hyperoxia in similar models of ischemia-reperfusion. Hyperoxia after graft reperfusion during orthotopic LT could increase lactate levels and worsen patient outcomes.
We conducted a retrospective and monocentric pilot study. All adult patients who underwent LT from 26 July 2013 to 26 December 2017 were considered for inclusion. Patients were classified into two groups according to oxygen levels before graft reperfusion: the hyperoxic group (PaO > 200 mmHg) and the nonhyperoxic group (PaO < 200 mmHg). The primary endpoint was arterial lactatemia 15 min after graft revascularization. Secondary endpoints included postoperative clinical outcomes and laboratory data.
A total of 222 liver transplant recipients were included. Arterial lactatemia after graft revascularization was significantly higher in the hyperoxic group (6.03 ± 4 mmol/L) than in the nonhyperoxic group (4.81 ± 2 mmol/L), < 0.01. The postoperative hepatic cytolysis peak, duration of mechanical ventilation and duration of ileus were significantly increased in the hyperoxic group.
In the hyperoxic group, the arterial lactatemia, the hepatic cytolysis peak, the mechanical ventilation and the postoperative ileus were higher than in the nonhyperoxic group, suggesting that hyperoxia worsens short-term outcomes and could lead to increase ischemia-reperfusion injury after liver transplantation. A multicenter prospective study should be performed to confirm these results.
肝移植（LT）期间高氧血症很常见，但并无任何指南支持。近期研究表明，在类似的缺血再灌注模型中，高氧血症具有潜在的有害作用。原位肝移植术中移植物再灌注后的高氧血症可能会增加乳酸水平，并使患者预后恶化。
我们开展了一项回顾性单中心试点研究。纳入了2013年7月26日至2017年12月26日期间接受肝移植的所有成年患者。根据移植物再灌注前的氧水平将患者分为两组：高氧组（动脉血氧分压>200 mmHg）和非高氧组（动脉血氧分压<200 mmHg）。主要终点是移植物血管再通后15分钟时的动脉血乳酸水平。次要终点包括术后临床结局和实验室数据。
共纳入222例肝移植受者。高氧组移植物血管再通后的动脉血乳酸水平（6.03±4 mmol/L）显著高于非高氧组（4.81±2 mmol/L），<0.01。高氧组术后肝细胞溶解峰值、机械通气时间和肠梗阻持续时间均显著增加。
高氧组的动脉血乳酸水平、肝细胞溶解峰值、机械通气时间和术后肠梗阻情况均高于非高氧组，这表明高氧血症会使短期预后恶化，并可能导致肝移植后缺血再灌注损伤增加。应开展多中心前瞻性研究以证实这些结果。
