原位肝移植早期移植肝功能的临床评价

Clinical Assessment of Initial Graft Function in Orthotopic Liver Transplantation

目的评价原位肝移植术后早期移植肝的功能状况。方法选择接受原位肝移植术的患者20例(连续病例)。分别于9个时间点测定血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)水平。供肝于冷缺血末期常规进行组织病理学检查。根据肝移植术后72 h内ALT和(或)AST水平(1 500 IU/L为界),将20例患者分为初期移植物功能不良(IPGF)组和非IPGF组,比较两组患者各时间点的ALT、AST、LDH水平,并进行相关性分析。结果20例患者中IPGF组7例,非IPGF组13例。供肝冷缺血末期病理检查显示,IPGF组中4例有轻度大泡型脂肪变性,而非IPGF组中未见脂肪变性(P=0.007)。IPGF组血清ALT水平于再灌注后3、6 h显著高于非IPGF组,其血清AST水平在再灌注后1、3、6、12 h时间点显著高于非IPGF组,而LDH在再灌注后1、3、6 h时间点显著高于非IPGF组(P均<0.05);LDH与ALT(r=0.948,P<0.001)及AST(r=0.646,P<0.01)呈显著正相关。结论供肝脂肪变性对原位肝移植后移植肝功能不良有直接影响;血清AST和ALT水平仍是反映早期移植肝功能状况的可靠指标;LDH与ALT和AST存在良好的相关性,可在一定程度上反映出术后早期移植肝功能情况。

Objective To evaluate the status of hepatic graft in orthotopic liver transplantation. Methods A sequence of 20 recipients receiving orthotopic liver transplantation were selected. The levels of serum alanine aminotransferase （ ALT）, aspartate aminotransferase （AST） and lactate dehydrogenase （ LDH ） were determined at 9 time points. All donor liver biopsies were performed at the end of cold ischemia phase. The group of initial poor graft function（IPGF） was confirmed if ALT and/or AST was above 1 500 IU/L within 72 h after orthotopic liver transplantation, while the group of nonIPGF below 1 500 IU/L. Results There were 7 cases in IPGF group and 13 cases in non-IPGF group. Hepatic biopsy at the end of cold ischemia phase showed that there were 4 cases of mild macrovesicular steatosis in IPGF group, while non in non-IPGF group （P =0. 007）. The levels of ALT at the time point of 3,6 h, AST at the time point of 1,3,6,12 h, and LDH at the time point of 1,3,6 h after reperfusion in IPGF group were significantly higher than those in non-IPGF group （P 〈0.05 ）. The level of LDH was well positively correlated with the level of ALT（ r =0. 948, P〈0.001） and AST （r=0.646, P〈0.01）. Conclusion Steatosis of donor liver has direct influence on the poor graft function after orthotopic liver transplantation. The levels of AST and ALT are still reliable parameters for the evaluation of initial hepatic graft function. The level of LDH has good correlation with the levels of ALT and AST which could reflect initial graft function in a certain extent after orthotopic liver transplantation.