| Liver transplantation is becoming a kind of effective treatments for unreversible severe liver diseases. Poor graft function secondary to injury by ischemia and reperfusion remains a major problem in clinical liver transplantations. At the same time, acute alterations for blood stream and inner environmental turbulence were also regarded as important influencing factors for the prognosis in liver transplantation patients. Then, researchers tried their best to abate the injurys by ischemia and reperfusions in liver transplantations in order to improve the prognosis for patients. It was firstly reported by Kniepeiss in 2003 that the graft function might be improved and post-reperfusion injury might be reduced by method of retrograde flushing via caval veins in piggyback liver transplantations. As a new kind of reperfusion, there were seldom reports on this method in orthotopic liver transplantations. In this study, the retrograde reperfusion via caval veins and tranditonal reperfusion via portal veins were contrastively studyed. The influences on injurys by ischemia and reperfusion, blood stream changes would be studyed in this research.Part 1 Study on the influences of injurys by ischemia and reperfusion secondary to retrograde reperfusion in standard orthotopic liver transplantations.Objective Study on the influences of injurys by ischemia and reperfusion secondary to retrograde reperfusion in orthotopic liver transplantations.Methods Thirty five standard orthotopic liver transplantation patients were randomly divided into experimental group and control group. Retrograde reperfusions via caval veins were performed in experimental group (17 cases) and normal reperfusions via portal veins were performed in control group (18 cases). The re-warm ischemia time, ALT, GGT, TB and PT in patients'serum were tested in the two groups respectively at one hour, 1 day, 2, 3, 5 and 7 days after operation. Concentrations of TNFαand IL-1 in the caval veins were also tested two hours after the grafts transplanted into the patients. The ratio of hydropic degeneration and necrotic hepatocytes were detected under the light microscope and the morphologic changes of hepatocytes were detected under light and electro microscope respectively.Results The re-warm ischemia time of experimental group was remarkably shorter than that of control group (P＜0.05) . For serum TB, the experimental group was remarkably lower than the control group 1 hour, 1 and 2 days after operation (P＜0.05) , but there were no significant differences between the two groups 3, 5 and 7 days after operation. For serum ALT, the experimental group was remarkably lower than the control group 1 and 2 days after operation(P＜0.05), but there were no significant differences between the two groups 1 hour, 3, 5 and 7 days after operation. For serum GGT, the experimental group was remarkably lower than the control group lhour, land 3 days after operation (P＜0.05) , but there were no significant differences between the two groups 2, 5 and 7 days after operation. For PT, there were no significent differences between the two groups after operation. Concentrations of TNF-αand Ih-1 in the caval veins of experimental group were remarkably lower than those of control group two hours after the grafts transplanted into the patients (P＜0.05). The injury by ischemia and reperfusion, ratio of hydropic degeneration and hepatocyte necrosis for experimental group were remakably lighter than control group(P＜0.05).Conclusion The injurys caused by ischemia and reperfusion might be reduced and the graft functions might be improved by using method of retrograde reperfusion in orthotopic liver transplantations.Part 2 Study on the changes of blood stream caused by retrograde reperfusion in standard orthotopic liver transplantations.Objective Study on the changes of blood stream caused by retrograde reperfusion in orthotopic liver transplantations.Methods Thirty five standard orthotopic liver transplantation patients were randomly divided into experimental group and control group. Retrograde reperfusions via caval veins were performed in experimental group (17 cases) and normal reperfusions via portal veins were performed in control group (18 cases). The SBP, DBP, CVP, HR of the two groups were tested at different time points before and after the graft transplanted into the patients. The urine quantity and dosage of intro-venous baking soda during the operation were mesured for the two groups.Results The blood stream for the two groups remained jarless before the liver resected. But the SBP, DBP, CVP droped at the morment of the liver resection for the two groups. For the experimental group, the blood stream became balanced gradually with the progress of retrograde reperfusion (SBP, DBP and CVP were increased graduall). The changes of blood stream balance for experimental group were remarkably lighter than control group (p＜0.05). The dosage of intro-venous baking soda for experimental group was remarkably less than control group during the operation(p＜0.05).Conclusion Retrograde reperfusion might reduce the post-reperfusion syndrome, the influences for blood stream for orthotopic liver transplantation patients.
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