Tojimbara T, Wicomb W N, Garcia-Kennedy R, Burns W, Hayashi M, Collins G, Esquivel C O
Department of Surgery, Stanford University Medical Center, California, USA.
Liver Transpl Surg. 1997 Jan;3(1):39-45.
We evaluated the effect of warm (37 degrees C) versus cold (4 degrees C) solutions as the initial flush for liver preservation from non-heart beating donors in rats.
An initial flush was performed just before donor hepatectomy with cold or warm University of Wisconsin solution (UW), UW without hydroxyethyl starch, sodium lactobionate sucrose solution, or lactated Ringer's solution as the control group. A separate group also used as control received no initial flushing. Liver transplantation was performed, and the graft function was determined by survival and assessment of enzyme release. The viscosity of each solution and the vascular resistance of the graft were measured.
The 7-day survival rate was 83% and 100% in the warm and cold sodium lactobionate sucrose solution groups and 60% and 50% in the warm and cold lactated Ringer's solution groups, respectively. In the no-initial-flush group, rats did not survive. The 7-day survival rate was 67% and 0% in the warm and cold UW groups, respectively. Eliminating the hydroxyethyl starch from the cold UW improved the survival to 67%. Serum alanine aminotransferase levels 1 day after transplantation in the no-initial-flush and the cold UW groups were significantly higher than those of the remaining groups. At 4 degrees C the viscosity was higher in the UW (86.2 cp) compared to hydroxyethyl starch-free UW solution (30.9 cp), lactated Ringer's solution (24.5 cp), and sodium lactobionate sucrose solution (32.7 cp). The viscosity of UW at 37 degrees C was 34.7 cp. Vascular resistance correlated well with the viscosity. Livers flushed with solutions with a low viscosity showed lower vascular resistance than those flushed with cold UW and led to better survival.
These data suggest that the viscosity of the initial flushing solution may play an important role in determining the outcome of organ procurement from non-heart beating donors.
我们评估了在大鼠中，用温（37摄氏度）溶液与冷（4摄氏度）溶液作为非心脏跳动供体肝脏保存的初始冲洗液的效果。
在供体肝切除术前，分别用冷或温的威斯康星大学溶液（UW）、不含羟乙基淀粉的UW、乳糖酸钠蔗糖溶液或乳酸林格氏液进行初始冲洗，乳酸林格氏液组作为对照组。另一单独的对照组不进行初始冲洗。进行肝移植，并通过存活情况和酶释放评估来确定移植物功能。测量每种溶液的粘度以及移植物的血管阻力。
温、冷乳糖酸钠蔗糖溶液组的7天存活率分别为83%和100%，温、冷乳酸林格氏液组分别为60%和50%。在无初始冲洗组中，大鼠未能存活。温、冷UW组的7天存活率分别为67%和0%。从冷UW中去除羟乙基淀粉后，存活率提高到67%。无初始冲洗组和冷UW组移植后1天的血清丙氨酸转氨酶水平显著高于其余组。在4摄氏度时，UW的粘度（86.2厘泊）高于不含羟乙基淀粉的UW溶液（30.9厘泊）、乳酸林格氏液（24.5厘泊）和乳糖酸钠蔗糖溶液（32.7厘泊）。37摄氏度时UW的粘度为34.7厘泊。血管阻力与粘度密切相关。用低粘度溶液冲洗的肝脏比用冷UW冲洗的肝脏血管阻力更低，存活率更高。
这些数据表明，初始冲洗液的粘度可能在决定非心脏跳动供体器官获取的结果中起重要作用。
