Vuković R, Simić M, Tasić M
Zavod za sudsku medicinu, Medicinski fakultet, Novi Sad.
Med Pregl. 1996;49(7-8):263-7.
Liver and sinusoidal wall cells become swollen very fast due to ischemia in liver allograft, with Eurocollins preservation solution. This process consequently narrows the sinusoidal lumen and significantly disturbs the "functional structure" of Rapaport microcirculation units. Advanced changes on "functional structure" microcirculation liver units can cause outflow block phenomenon of the liver and a consequential primary graft dysfunction. In order to avoid this unfavorable consequence of transplantation, it is necessary to assess the potential allograft vitality in advance. The assessment can be based on measuring values of sinusoidal volume, increase of the serum glutaminpyruvic transaminaze (SGPT) level per mass unit of liver tissue in the preservation solution and increase of necrotizing hepatocytes' number in liver lobules. During the first 8 hours of cold ischemia these values do not change significantly, so we can conclude that in this interval of cold ischemia liver is suitable for transplantation, which is not the case with warm ischemia where changes occur much earlier. Practically, the intensity of lesions with 4 hour period of warm ischemia equals the intensity of lesions with 16 hour period of cold ischemia.
使用优思林保存液时,肝移植中肝脏和肝血窦壁细胞会因缺血而很快肿胀。这一过程会使肝血窦管腔变窄,并严重扰乱拉帕波特微循环单位的“功能结构”。肝微循环单位“功能结构”的进一步变化会导致肝脏出现流出道阻塞现象,进而引发原发性移植物功能障碍。为避免移植出现这种不利后果,有必要提前评估移植物的潜在活力。评估可基于肝血窦容积测量值、保存液中每单位质量肝组织血清谷丙转氨酶(SGPT)水平的升高以及肝小叶中坏死肝细胞数量的增加。在冷缺血的最初8小时内,这些值变化不明显,所以我们可以得出结论,在这段冷缺血时间内肝脏适合移植,而热缺血时情况并非如此,热缺血时变化出现得更早。实际上,4小时热缺血的损伤强度等同于16小时冷缺血的损伤强度。