不同热缺血时间对大鼠移植肝功能状态及存活期的影响

Effect of warm ischemia injury on hepatic functional status and s urvival of liver graft in rats

目的 探讨不同热缺血时间条件下 ,大鼠原位肝移植术后肝脏功能和组织形态变化规律 ,并对动物远期存活情况进行观察 ,预测无心跳供体 (NHBD )中供肝耐受热缺血的安全时限。方法 实验动物按供肝热缺血时间分别为 0、10、15、2 0、30、45、6 0min ,随机分为 7组。然后按各组条件分别作原位肝移植 ,观察肝移植后 2 4、48h、3和 5d各组肝脏功能和组织形态的恢复性变化 ,并统计生存时间。结果 供肝经受 30min以内热缺血损伤 ,各组移植术后生存天数差异无显著性 ,热缺血 30min组 ,肝移植术后 1周的存活率达到 83 .3 % ( 10 /12 ) ,1个月和 3个月存活率分别为5 8.3 % ( 7/12 )和 5 0 .0 % ( 6 /12 )。热缺血 45min组 ,术后 1周的存活率为 6 6 .7% ( 8/12 ) ,但 1个月和 3个月存活率分别为 33 .3 % ( 4/12 )和 8.3 % ( 1/12 )。至于热缺血 6 0min组 ,1周的存活率仅为8.3 % ( 1/12 )。结论 大鼠的供肝可以安全地耐受 30min以内的热缺血。 45min的热缺血损伤 ,虽对术后 1周存活率无明显影响 ,但大鼠肝移植术后的远期存活时间明显缩短。 6 0min以后 ,移植肝组织的结构和功能均难以恢复 ,大鼠术后生存天数显著降低。

Objective To investigate the changing p at terns of function and posttransplantive survival of liver graft under different warm ischemia time (WIT) in rats and determine the maximum limitation of liver g raft to warm ischemia.Methods According to WIT (0,10,15, 20,30,45,60 min),the rats were randomized into 7 groups.Serum concentration s of alanine aminotransferase (ALT),aspartate aminotransferase (AST),and lacta te dehydrogenase (LDH) were measured at the day 1,2,3 and 5 after orthotopic l iver transplantation (OLTx) respectively.All liver graft specimens were subject ed to histopathological observation at the same intervals.The survival of the r ats in each subgroup was observed.Results In terms of gra ft survival,there was no significant difference between subgroups within 30 min of WIT.In the 30 min WIT group,the one week,one month and 3 month survival r ates in the recipient rats were 83.3 % (10/12),58.3 % and 50.0 % (6/12) respect ively.In the 45 min WIT group,the one week,one month and 3 month survival rat es in the recipient rats were 66.7 % (8/12),33.3 % (4/12) and 8.3 % (1/12) resp ectively.However,in the 60 min WIT group,the one week survival rate of the ra ts was only 8.3 % (1/12).Conclusion Rat liver graft could be safely subject to warm ischemia within of 30 min.When WIT was prolonged to 45 min,the recipients' long-term survival was severely insulted,and both func tion and histological structure of liver graft would develop irreversible damage when WIT was prolonged to 60 min.