Alleviating graft injury during liver transplantation by improving retrograde perfusion in standard orthotopic liver transplantation

作者：Cai, Qiucheng; Li, Sirun; Jiang, Yi^*; Lin, Bangbang; Yang, Fang; Chen, Yongbiao; Zhang, Xiaojin; Hu, Huanzhang; Pan, Fan; Zhang, Kun; Lv, Lizhi; Chen, Shaohua

来源：International Journal of Clinical and Experimental Medicine, 2016, 9(2): 4364-4371.

• Orthotopic liver transplantation
• liver disease
• improved method of retrograde perfusion
• portal vein
• blood
• biochemistry

This study aimed to explore the influence of improved retrograde perfusion in standard orthotopic liver transplantation on graft injury during surgery. Twenty-one patients who had undergone an improved method of retrograde perfusion in standard orthotopic liver transplantation comprised the experimental group, and 21 patients in the same period who had undergone the perfusion method in standard orthotopic liver transplantation comprised the control group. The results of the liver function tests in the two groups were compared after transplantation. In 21 patients, the time before inferior vena cava opening (T1), right inferior vena cava (RIVC) blood retrograde perfusion, and bleeding of 10 (T2), 50 (T3) and 200 mL (T4) from the portal vein, respectively, were recorded. Blood from the RIVC at T1, and donor hepatic portal vein blood at T2, T3, and T4, were extracted for biochemical testing and blood gas analysis, in order to compare changes in venous blood pH, PaCO2, PaO2, base excess of extracellular fluid (BEecf), HCO3-, T-CO2, SaO(2), alanine aminotransferase (ALT), gamma glutamyltransferase (GGT), K+, alkaline phosphatase (AKP) and aspartate aminotransferase (AST) at different times. The differences between the two groups in levels of AKP, total bilirubin (TBil), ALT, GGT, and AST after surgery were statistically significant (P<0.05). The pH, PaCO2, PaO2, BEecf, HCO3-, T-CO2, and SaO(2) levels in the blood gas analysis demonstrated various fluctuations at T2 and T3, as well as significant differences between T1 and T4 (P<0.05). The HCO3- and T-CO2 values at T4 eventually returned to T1 levels (P>0.05), while the pH, PaO2, BEecf, and SaO(2) levels were higher than those at T1 (P<0.05). The PaCO2 levels at T4 were lower than those at T1 (P<0.05). The biochemical test results indicated that the ALT, AST, AKP, and K+ from T1 to T4 all increased to their highest levels at T2, and declined to the lowest level at T4, but were still higher than those at T1. The differences in levels between any two points were statistically significant (P<0.05). The GGT levels increased at T2 and T3, and again decreased at T4 to levels that were lower than those at T1. The differences between T1 and T2, as well as between T3 and T4, were statistically significant (P<0.05), while the differences between T1 and T4 were not statistically significant (P>0.05). RIVC blood retrograde perfusion to the donor liver can rapidly reduce ischemia-reperfusion injury in standard orthotopic liver transplantation.

• 出版日期2016
• 单位中国人民解放军南京军区福州总医院