Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Department for BioMedical Research, Visceral Surgery and Medicine, University of Bern, Switzerland.
Liver Transpl. 2023 Nov 1;29(11):1226-1233. doi: 10.1097/LVT.0000000000000252. Epub 2023 Sep 21.
An ischemia-reperfusion injury (IRI) results from a prolonged ischemic insult followed by the restoration of blood perfusion, being a common cause of morbidity and mortality, especially in liver transplantation. At the maximum of the potential damage, IRI is characterized by 2 main phases. The first is the ischemic phase, where the hypoxia and vascular stasis induces cell damage and the accumulation of damage-associated molecular patterns and cytokines. The second is the reperfusion phase, where the local sterile inflammatory response driven by innate immunity leads to a massive cell death and impaired liver functionality. The ischemic time becomes crucial in patients with underlying pathophysiological conditions. It is possible to compare this process to a shooting gun, where the loading trigger is the ischemia period and the firing shot is the reperfusion phase. In this optic, this article aims at reviewing the main ischemic events following the phases of the surgical timeline, considering the consequent reperfusion damage.
缺血再灌注损伤（IRI）是由长时间缺血后再灌注引起的，是发病率和死亡率的一个主要原因，尤其是在肝移植中。在潜在损伤的最大值时，IRI 有两个主要阶段。第一是缺血期，在此期间，缺氧和血管淤滞会导致细胞损伤以及损伤相关分子模式和细胞因子的积累。第二是再灌注期，在此期间，先天免疫驱动的局部非感染性炎症反应会导致大量细胞死亡和肝功能受损。在有潜在病理生理状况的患者中，缺血时间变得至关重要。可以将这个过程比作一把上膛的枪，加载扳机是缺血期，发射子弹是再灌注期。从这个角度来看，本文旨在回顾手术时间线上的各个阶段后的主要缺血事件，并考虑随之而来的再灌注损伤。
