Hertl M, Chartrand P B, West D D, Harvey P R, Strasberg S M
Department of Surgery, Washington School of Medicine, St. Louis, Missouri 63110.
Cryobiology. 1994 Oct;31(5):434-40. doi: 10.1006/cryo.1994.1053.
The optimal preservation temperature for liver allografts is unknown. We evaluated the effect of small differences in preservation temperature, 5 degrees C vs 0 degrees C, on outcome of prolonged preservation. Livers of Wistar rats were preserved at these temperatures in UW solution for 40 h. Function was studied during reperfusion on the isolated perfused rat liver system at 37 degrees C. To compare the effects of a small reduction in temperature with known beneficial strategies, the effects of including antiproteases and periodic flushing of the graft with UW solution during cold preservation at 5 degrees C were also studied. Aspartate transaminase (AST) and alanine transaminase release after 4 h of reperfusion were much higher in the livers stored at 5 than at 0 degrees C (P < 0.0005). Addition of antiproteases to the preservation solution or periodic flushing reduced AST release but neither treatment at 5 degrees C was as good as simple storage at 0 degrees C. Cumulative bile production after 4 h of reperfusion was significantly greater in the 0 degrees C preserved group than in liver at 5 degrees C or 5 degrees C with periodic flushing. The addition of antiproteases resulted in slightly increased bile production (not significant). Platelets and WBCs in the perfusate decreased during reperfusion. This effect was more pronounced in the 5 degrees C preserved livers than in those stored at 0 degrees C. Antiproteases in the preservation solution appeared to inhibit platelet and WBC loss. Perfusate flow was significantly higher in the 0 degrees C group. We conclude that small differences in preservation temperature even at these low temperatures are important in postreperfusion liver function.
同种异体肝移植的最佳保存温度尚不清楚。我们评估了保存温度的微小差异（5摄氏度与0摄氏度）对延长保存效果的影响。将Wistar大鼠的肝脏在这些温度下于UW溶液中保存40小时。在37摄氏度的离体灌注大鼠肝脏系统再灌注期间研究肝功能。为了将温度小幅降低的效果与已知的有益策略进行比较，还研究了在5摄氏度冷保存期间加入抗蛋白酶以及用UW溶液定期冲洗移植物的效果。再灌注4小时后，5摄氏度保存的肝脏中天冬氨酸转氨酶（AST）和丙氨酸转氨酶的释放量比0摄氏度保存的肝脏高得多（P < 0.0005）。在保存液中添加抗蛋白酶或定期冲洗可降低AST释放，但5摄氏度下的这两种处理均不如简单地在0摄氏度保存效果好。再灌注4小时后的累积胆汁生成量在0摄氏度保存组中显著高于5摄氏度保存的肝脏或5摄氏度定期冲洗的肝脏。添加抗蛋白酶导致胆汁生成略有增加（不显著）。再灌注期间灌注液中的血小板和白细胞减少。这种效应在5摄氏度保存的肝脏中比在0摄氏度保存的肝脏中更明显。保存液中的抗蛋白酶似乎抑制了血小板和白细胞的损失。0摄氏度组的灌注液流量显著更高。我们得出结论，即使在这些低温下，保存温度的微小差异对再灌注后肝功能也很重要。
