Valero R, García-Valdecasas J C, Tabet J, Taurá P, Rull R, Beltran J, García F, González F X, López-Boado M A, Cabrer C, Visa J
Department of Anesthesiology, Hospital Clinic of Barcelona, Spain.
Transplantation. 1998 Jul 27;66(2):170-6. doi: 10.1097/00007890-199807270-00005.
Our aim was to evaluate the hepatic blood flows and oxygen metabolism of non-heart-beating donor (NHBD) pigs, with the use of cardiopulmonary bypass (CPB) and normothermic recirculation (NR) before total body cooling, and its relationship with recipient survival.
Thirty-five pigs were transplanted with an allograft from NHBDs. After warm ischemia (WI) time (20, 30, or 40 min), CPB and NR were run for 30 min. After this period, the animals were cooled to 15 degrees C. In the control group (20 min of WI), the period of NR was excluded. Liver procurement was then performed.
Survival rate was 100% in the 20WI, 70% in the 30WI, and 50% in the 40WI. Control group survival rate was 0%. Hepatic artery blood flow and portal blood flow recovered during NR. Pump blood flow during CPB increased rapidly during NR and was significantly higher in the 20WI. When donors of the livers transplanted in "surviving pigs" (DSP) were compared with donors of the livers transplanted in "nonsurviving pigs" (DNSP), hepatic artery blood flow, portal blood flow, and pump blood flow were higher in the DSP. Hepatic oxygen extraction ratio increased in the three groups with respect to baseline values. Hepatic oxygen extraction ratio was lower in the 20WI than in the other groups and was lower in the DSP than in the DNSP.
The use of a NR period before total body cooling improves survival of liver transplantation in NHBDs. Portal blood flow and pump blood flow measurements can predict the viability of the grafts.
我们的目的是通过在全身冷却前使用体外循环（CPB）和常温再灌注（NR）来评估非心脏跳动供体（NHBD）猪的肝血流和氧代谢，以及其与受体存活的关系。
35头猪接受了来自NHBD的同种异体移植。在热缺血（WI）时间（20、30或40分钟）后，进行30分钟的CPB和NR。在此期间后，将动物冷却至15摄氏度。在对照组（WI 20分钟）中，排除NR期。然后进行肝脏获取。
20WI组的存活率为100%，30WI组为70%，40WI组为50%。对照组存活率为0%。NR期间肝动脉血流和门静脉血流恢复。CPB期间的泵血流量在NR期间迅速增加，并且在20WI组中显著更高。当比较“存活猪”（DSP）中移植肝脏的供体与“非存活猪”（DNSP）中移植肝脏的供体时，DSP组的肝动脉血流、门静脉血流和泵血流量更高。三组的肝氧摄取率相对于基线值均增加。20WI组的肝氧摄取率低于其他组，且DSP组低于DNSP组。
在全身冷却前使用NR期可提高NHBD肝移植的存活率。门静脉血流和泵血流量测量可预测移植物的活力。
