供肝热缺血损伤对大鼠肝移植术后胆汁淤积的影响

THE EFFECT ON CHOLESTASIS INDUCED BY GRAFT WARM ISCHEMIA INJURY FOLLOWING RAT LIVER TRANSPLANTATION

目的探讨肝移植中供肝热缺血损伤对肝移植术后胆汁淤积的影响。方法实验分为4组:对照组(C)和移植组,移植组根据供肝获取前经历供体心脏停搏时间的不同分为三组:热缺血0min(W0)、热缺血15min(W15)和热缺血30min(W30),其后建立大鼠动脉化原位肝移植模型,每组均为30只大鼠,分别于术后3d、7d、14d和30d处死,每个时间点各取6只大鼠,分别测定移植肝组织学、血清ALP和ALT变化。此外,移植组各组随机选取6只大鼠观察长期生存率(>100d)。结果随着供肝热缺血时间的延长,术后血清ALP逐渐增高,14天达到高峰后逐渐下降。术后第3d、7d、14d、30d血清ALP与供肝热缺血时间具有显著相关性。随着供肝热缺血时间的延长,移植肝损伤加重,并且恢复过程也延长。移植组和对照组术后血清ALT无显著性改变。W0、W15和W30术后长期生存率无明显差别。结论肝移植术后存在胆汁淤积,供肝热缺血时间的延长明显加重胆汁淤积的程度。但是,供肝热缺血30min以内造成的大鼠肝移植术后胆汁淤积并不影响预后。

Objective To study the effect on cholestasis due to graft warm ischemia injury following orthotopic liver transplantation. Methods The rats were divided into four groups （ n = 30/group） including the control group and 3 liver transplantation groups in which cardiac arrest time was 0, 15, 30 rain（ W0 ,W15 ,W30） respectively, then the model of orthotopic liver transplantation with arterial reconstruction was established. To evaluate histology and hepatic function, 6 rats in each group were sacrificed on postoperative day （POD） 3, 7, 14 and 30 respectively. The long-term survival （longer than 100 days） rate were compared （n = 6） among liver transplantation groups. Results ALP level increased with the warm ischemia time of the graft and peaked on PODI4. The correlation between the warm ischemia time of the graft and serum ALP level was observed. Histological studies showed that longer the warm ischemia time, increased in restoration time of the liver as well as aggravated liver parenehyma injury. Serum levels of ALT in all groups showed no marked difference. The long-term survival of W0, W15 and W30 were 100. 0% （15/15） ,93.3% （14/15） ,86. 7% （13/15） and 100. 0% （6/6） ,83.3 % （ 5/6 ）, 66. 7 % （4/6） respectively, which showed no significant difference. Conclusion Cholestasis was evident alter liver transplantation and aggravated with increased warm ischemia time of the graft. But eholestasis induced by graft warm isehemia in 30 minutes don＇t change prognosis.