Clavien P A, Harvey P R, Sanabria J R, Cywes R, Levy G A, Strasberg S M
Samuel Lunenfeld Research Institute, University of Toronto, Canada.
Hepatology. 1993 Jan;17(1):131-42.
Leukocyte adhesion may play a central role in the pathogenesis of preservation-reperfusion injury to liver grafts. We previously showed that lymphocyte adhesion to sinusoids is dependent on the length of cold ischemia. In the present study we examined the mechanisms of lymphocyte adherence after harvesting combined with a short and a long preservation time. The effects of lymphocyte adherence on liver function were also examined. Rat livers were stored at 1 degrees C in University of Wisconsin solution for 45 min or 30 hr and then reperfused at 37 degrees C in the isolated perfused rat liver with isogeneic lymphocytes in an asanguineous perfusate. The role of reactive oxygen intermediates was investigated with allopurinol, a vitamin E analog and ascorbate or superoxide dismutase and catalase. For us to determine the role of Kupffer cells, Kupffer cell blockade was produced by gadolinium chloride. Leukotriene B4 effects were examined with the lipooxygenase inhibitor, nordihydroguaiaretic acid. We evaluated the possible presence of mechanical obstruction by studying flow rates and the circulation of red blood cells. We examined the role of adhesion molecules by pretreating lymphocytes with trypsin or neuraminidase and by exposing livers to arabinogalactan. We investigated the effects of lymphocyte adhesion on liver function by comparing perfusate liver enzymes in livers reperfused with and without lymphocytes, with trypsinized lymphocytes and with an increased number of lymphocytes. Allopurinol significantly reduced hypoxanthine degradation, and nordihydroguaiaretic acid inhibited leukotriene B4 release into the perfusate. The ability of gadolinium chloride to inhibit Kupffer cells was shown by colloid carbon uptake. In livers harvested and preserved for 45 min, lymphocytes decreased about 40% during reperfusion. In livers preserved for 30 hr, the reduction was significantly greater (about 80%). Lymphocyte adherence was lessened in livers preserved for 45 min by all three of the reactive oxygen intermediate protectants and by gadolinium chloride. In contrast, neither reactive oxygen intermediate protectants nor gadolinium chloride reduced adherence in livers preserved for 30 hr. Nordihydroguaiaretic acid had no effect in livers preserved for either 45 min or 30 hr. Portal flow in livers preserved for 45 min and 30 hr was similar, suggesting an absence of mechanical obstruction, and this finding was supported by a complete absence of red cell trapping. Trypsinization of lymphocytes and exposure of livers to arabinogalactan significantly lessened lymphocyte adherence in livers preserved for 30 hr but not in those preserved for 45 min.(ABSTRACT TRUNCATED AT 400 WORDS)
白细胞黏附可能在肝移植保存 - 再灌注损伤的发病机制中起核心作用。我们之前表明淋巴细胞与肝血窦的黏附取决于冷缺血时间。在本研究中,我们研究了收获后短时间和长时间保存相结合情况下淋巴细胞黏附的机制。还研究了淋巴细胞黏附对肝功能的影响。将大鼠肝脏在威斯康星大学溶液中于1℃保存45分钟或30小时,然后在37℃下在离体灌注大鼠肝脏中用同基因淋巴细胞在无血灌注液中进行再灌注。用别嘌呤醇、维生素E类似物和抗坏血酸或超氧化物歧化酶和过氧化氢酶研究活性氧中间体的作用。为了确定库普弗细胞的作用,用氯化钆阻断库普弗细胞。用脂氧合酶抑制剂去甲二氢愈创木酸研究白三烯B4的作用。通过研究流速和红细胞循环来评估机械性梗阻的可能性。通过用胰蛋白酶或神经氨酸酶预处理淋巴细胞以及将肝脏暴露于阿拉伯半乳聚糖来研究黏附分子的作用。通过比较有淋巴细胞和无淋巴细胞再灌注的肝脏、用胰蛋白酶处理的淋巴细胞再灌注的肝脏以及淋巴细胞数量增加的肝脏中的灌注液肝酶,来研究淋巴细胞黏附对肝功能的影响。别嘌呤醇显著降低次黄嘌呤降解,去甲二氢愈创木酸抑制白三烯B4释放到灌注液中。氯化钆抑制库普弗细胞的能力通过胶体碳摄取得以显示。在收获并保存45分钟的肝脏中,再灌注期间淋巴细胞减少约40%。在保存30小时的肝脏中,减少幅度明显更大(约80%)。在保存45分钟的肝脏中,所有三种活性氧中间体保护剂和氯化钆都减少了淋巴细胞黏附。相比之下,活性氧中间体保护剂和氯化钆都没有减少保存30小时的肝脏中的黏附。去甲二氢愈创木酸对保存45分钟或30小时的肝脏均无影响。保存45分钟和30小时的肝脏门静脉血流相似,表明不存在机械性梗阻,这一发现得到红细胞无滞留现象的支持。淋巴细胞的胰蛋白酶处理以及肝脏暴露于阿拉伯半乳聚糖显著减少了保存30小时的肝脏中的淋巴细胞黏附,但对保存45分钟的肝脏没有影响。(摘要截短于400字)