Post S, Palma P, Gonzalez A P, Rentsch M, Menger M D
Institute for Surgical Research, University of Munich, Federal Republic of Germany.
Ann Surg. 1994 Nov;220(5):691-8. doi: 10.1097/00000658-199411000-00014.
This study analyzed the pathophysiologic sequela of different modes of graft reperfusion in liver transplantation.
The grafted liver may be reperfused either immediately after completion of portal anastomosis followed by delayed arterial reconstruction or simultaneously by portal and arterial blood if all vascular anastomoses are completed during the anhepatic period.
Delayed arterialization, that is, arterial reperfusion 8 minutes after portal revascularization (n = 12), was compared with simultaneous arterialization (n = 8) using the model of syngeneic orthotopic liver transplantation in male Lewis rats. After cold storage for 24 hours in University of Wisconsin (UW) solution, intravital fluorescence microscopy was employed 30 to 90 minutes after reperfusion to assess hepatic microvascular perfusion, leukocyte accumulation, and phagocytic activity of Kupffer cells.
Compared with delayed arterialization, the number of both nonperfused acini and nonperfused sinusoids was reduced after simultaneous reperfusion by 71% (p = 0.008) and 78% (p < 0.001), respectively. Leukocyte accumulation in sinusoids and postsinusoidal venules after simultaneous arterialization decreased by 17% (p = 0.01) and 64% (P < 0.001), respectively. In addition, simultaneous revascularization was able to attenuate Kupffer cell activation, indicated by significantly slower adherence of latex beads injected 80 minutes after reperfusion. Improved hepatocellular excretory function after simultaneous arterialization was demonstrated by increased bile flow during the observation period of 90 minutes after reperfusion (2.24 +/- 0.7 vs. 0.95 +/- 0.4 mL/100 g liver [mean +/- SEM], p < 0.05).
Timing of arterial reperfusion in liver transplantation may be of critical importance in the prevention of various manifestations of reperfusion injury.
本研究分析了肝移植中不同移植物再灌注模式的病理生理后果。
移植肝可在门静脉吻合完成后立即再灌注，随后延迟进行动脉重建；或者如果在无肝期完成所有血管吻合，则同时进行门静脉和动脉血再灌注。
采用雄性Lewis大鼠同基因原位肝移植模型，将延迟动脉化（即门静脉再血管化8分钟后进行动脉再灌注，n = 12）与同时动脉化（n = 8）进行比较。在威斯康星大学（UW）溶液中冷藏24小时后，在再灌注后30至90分钟采用活体荧光显微镜评估肝微血管灌注、白细胞积聚以及库普弗细胞的吞噬活性。
与延迟动脉化相比，同时再灌注后未灌注腺泡和未灌注血窦的数量分别减少了71%（p = 0.008）和78%（p < 0.001）。同时动脉化后血窦和窦后小静脉中的白细胞积聚分别减少了17%（p = 0.01）和64%（P < 0.001）。此外，同时再血管化能够减轻库普弗细胞的活化，这表现为再灌注80分钟后注射的乳胶珠的黏附明显减慢。再灌注后90分钟的观察期内胆汁流量增加，证明了同时动脉化后肝细胞排泄功能得到改善（2.24 +/- 0.7对0.95 +/- 0.4 mL/100 g肝脏[平均值 +/- 标准误]，p < 0.05）。
肝移植中动脉再灌注的时机对于预防再灌注损伤的各种表现可能至关重要。
