Experimental Research On Intestinal Mucosal Barrier Function Changes During Reperfusion Of Donation After Cardiac Death Liver Grafts By Extracorporeal Membrane Oxygenation

BackgroundWith extracorporeal membrane oxygenation(ECMO) advanced in technology, its application is more and more widely. ECMO gradually applied to repair the damaged DCD organs for transplantation and to transport the circulatory failure grafts between hospitals. Yet the intestinal mucosal barrier function change during reperfusion of DCD liver grafts by ECMO hasn’t been reported and needed further research.Object1.To establish stable models of donation after cardiac death liver grafts reperfusion by extracorporeal membrane oxygenation.2.To observation the intestinal mucosal barrier changes during repurfusion of donation after cardiac death liver grafts by extracorporeal membrane oxygenation, and to set the foundation for further study of the influence and its mechanism of intestinal mucosal barrier function change to the liver. Provide a new path for the research of the ECMO mechanisms.Method1.Cardiac arrest was induced in 16 mini-pigs by administration of 1g KCL intravenously, followed by 30 minutes cardiopulmonary resuscitation(CPR) according to standard guideline. Then death was declared after 5 minutes of “no-touch” time without cardiac activities and spontaneous respiration. Through this way to establish a standard Maastricht type II donation after cardiac death model. An intravenous cannula was placed through aortaventralis and postcava, and connected to ECMO extracorporeal circulation pipes. Through this way to establish the models of donation after cardiac death liver grafts reperfusion by extracorporeal membrane oxygenation.2.To establish sixteen models of donation after cardiac death liver grafts reperfusion by extracorporeal membrane oxygenation. Blood samples and small intestine tissues were taken before cardiac death, after the declaration of cardiac death, 2 hours after ECMO circuit, 4 hours after ECMO circuit and 6 hours after ECMO circuit. To observe the pathology changes of the small intestinal mucosa. To analyze serum diamine oxidase(DAO), intestinal fatty acid binding protein(I-FABP), D-lactic acid and endotoxin levels in different times by ELISA. To analyze the small intestinal mucosa epithelium tight junction proteins(ZO-1, occluding, Claudin1) by Western blot. To observe the intestinal mucosal barrier function changes during repurfusion of DCD liver grafts by ECMO.Result1.16 models of donation after cardiac death liver grafts reperfusion by extracorporeal membrane oxygenation were all successfully established, the success rate is 100%. The hemodynamics was stable during ECMO circuit.2.After cardiac death, the indicators deteriorated. It suggests that intestinal mucosal barrier function injury is serious, with ECMO circuit for 4 hours, the indicators are better, which suggests intestinal mucosal barrier function to get recovery in some extent. When the ECMO circuit for 6 hours, some indicators deteriorated. There may be further intestinal mucosal barrier function injury existing.Conclusion1.The model of donation after cardiac death liver grafts reperfusion by extracorporeal membrane oxygenation was successfully established with mini-pigs, which is helpful for further study on the intestinal mucosal barrier function changes during ECMO circuit and their influence on liver, kidney, pancreas and other organs.2.During the DCD liver grafts reperfusion by ECMO, intestinal mucosal barrier function changes are as follows: after cardiac death, the intestinal mucosal barrier function injury is serious. With ECMO circuit for 4 hours, the intestinal mucosal barrier function get recovery in some extent. When the ECMO circuit for 6 hours, there may be further intestinal mucosal barrier function injury existing.