García-Valdecasas J C, Rull R, Grande L, Fuster J, Rimola A, Lacy A M, Gonzalez F X, Cugat E, Puig-Parellada P, Visa J
Department of Surgery, Liver Transplant Unit, Hospital Clínic of Barcelona, Spain.
Transplantation. 1995 Oct 15;60(7):662-7. doi: 10.1097/00007890-199510150-00008.
The aim of this prospective study is to evaluate prostanoid (prostacyclin and thromboxane) and lipid peroxide levels at the portal and hepatic veins, and their relation to immediate postoperative liver function. Nineteen patients with liver cirrhosis undergoing orthotopic liver transplantation were prospectively studied. Blood samples were obtained within 5 min and 1 and 2 hr after reperfusion of the new liver, through a catheter placed at the portal vein in the recipient and another at the left hepatic vein in the donor liver. Plasma prostacyclin and thromboxane were analyzed by HPLC and RIA. The formation of lipid peroxides was determined and expressed in terms of thiobarbituric acid-reacting substances. Immediate postoperative liver function was evaluated using the transaminase levels within the first 48 hr and the early postoperative graft function score, as described previously. After reperfusion, only determinations at 5 min were related with liver function. Either prostacyclin (R = -0.61, P = 0.004) levels at the hepatic vein or prostacyclin production (subtraction between hepatic and portal vein levels) (R = -0.47, P = 0.04) correlated significantly with the early postoperative graft function score. Besides, there was a significant relationship between lipid peroxide production as measured by thiobarbituric acid-reacting substances and a worse early postoperative graft function score (R = 0.61, P = .005). These results suggest that prostacyclin released after liver grafting attenuates preservation and reperfusion damage of the liver, supporting the hypothesis that there is an imbalance of prostanoids within the microvasculature in patients with a compromised postoperative liver function. Our results agree with the involvement of some degree of lipid peroxidation products in the damage of hepatocytes during anoxia and reperfusion.
这项前瞻性研究的目的是评估门静脉和肝静脉中前列腺素（前列环素和血栓素）及脂质过氧化物水平，以及它们与术后即刻肝功能的关系。对19例接受原位肝移植的肝硬化患者进行了前瞻性研究。在新肝再灌注后5分钟、1小时和2小时内，通过置于受者门静脉和供肝左肝静脉的导管采集血样。采用高效液相色谱法（HPLC）和放射免疫分析法（RIA）分析血浆前列环素和血栓素。测定脂质过氧化物的形成，并以硫代巴比妥酸反应物质表示。如前所述，使用术后48小时内的转氨酶水平和术后早期移植物功能评分评估术后即刻肝功能。再灌注后，仅5分钟时的测定结果与肝功能相关。肝静脉中前列环素水平（R = -0.61，P = 0.004）或前列环素生成量（肝静脉与门静脉水平之差）（R = -0.47，P = 0.04）与术后早期移植物功能评分显著相关。此外，硫代巴比妥酸反应物质测定的脂质过氧化物生成量与术后早期移植物功能较差的评分之间存在显著关系（R = 0.61，P = 0.005）。这些结果表明，肝移植后释放的前列环素可减轻肝脏的保存和再灌注损伤，支持术后肝功能受损患者微血管内前列腺素失衡的假说。我们的结果与一定程度的脂质过氧化产物参与缺氧和再灌注期间肝细胞损伤的观点一致。
