The Clinical Research About The Lung Injury After Liver Ischemia-reperfusion In The Liver Transplantation And The Influences Of Two Ways Of Liver Transplantation On Postoperative Pulmonary Complications

[objective]1.To study the effects of transplanted liver of ischemia-reperfusion to the pathophysiological changes of lung in the liver transplantation,and explore the mechanism of lung injury.2.To evaluate the effects of different classic liver transplantation and perioperative fluid therapy on pulmonary complications post operation and explore the risk factors which affect the pulmonary complications.[methods]1.We choose 23 cases from liver transplantation patients in Department of Hepatobiliary surgery Fuzhou General Hospital of Nanjing Military Region from November 2007 to November 2008.We separately cut a small piece of right lung organization for pathological and ultrastructure observation and L-1βand TNF-a immunohistochemistry experiments at the 5 minutes after the beginning of operation (T_a),the 5 minutes before the portal vein open(T_b) and the three hours after the new period of liver(T_c).we also collected the peripheral blood to detect the concentration of IL-1βand TNF-a in the plasma at the beginning of operation(T₁),the portal vein 5 minutes before opening(T₂),the portal vein ten minutes(T₃) after the opening,the one hours after the new period of liver(T₄),the three hours after the new period of liver(T₅),12 hours after operation(T₆).2.We retrospectively andforward-looking analyzed 129 patients receiving liver transplantation for end-stage liver disease between January 2006 and June 2008 in our hospital.We used mono-factorial and multivariate logistic regression analysis to investigate the relationship between the standard classic liver transplantation(group A) and modified classic liver transplantation(group B) and pulmonary complications and the following variables:age,sex the pre-operative Meld score,ascites condition and cold ischemia time of donor liver;intraoperation-two types of liver transplantation, total amount of the infusion,liquid volume of the crystal,liquid volume of the colloidal,total transfusion of blood products,the use of albumin,operation time,the time of anhepatic phase;daily volume of net fluid retention in the first 3 days after surgery.[Results]1.The influences of ischemic reperfusion to the injury of lung in the liver transplantation1.1 The cytokines TNF-a and IL- 1βwhich contain in peripheral blood was not obvious increased at the portal vein before opening,but significantly increased after the portal vein opening.T₁ and T₂ separately compared with T₃,T₄ and T₅ were significant difference P＜0.01.1.2 All of cases of lung tissue were observed under the light microscope and electron microscope.The structure of lung tissue was normal at Ta point and did not change significantly at Tb point,but there were significant abnormalities at T_c point.1.3 The TNF-a and IL-1βexpressed in Lung tissue by immunohistochemistry. All of cases of lung tissue were not obviously stained at T_a point and a small number of cases were mildly expressed at T_b point,but the majority of cases were significantly expressed at T_c point.The positive average points of TNF-a and IL-1βexpression at T_c point was significantly higher than the Ta and Tb point P＜0.01.2.The influence of perioperative fluid treatment by two ways of liver transplantation on pulmonary complications post operation2.1 The incidence of pulmonary complications was significantly lower at group B than group A in the situation of Meld score＜15 points and 15-25points. Compared the patient with group A,group B had a reduced total amount of the intraoperative infusion(P＝0.040) and larger number of patients whose fluid balance＜-300 ml for no less than 2 days in the first 3 days after operation(P＝0.038).2.2 The total amount of the intraoperative infusion＞10L(P＝0.026) and total intraoperative transfusion of blood products＞4L(P＝0.033) were the risk factors of pulmonary complications,while the modified classic liver transplantation(P＝0.041) and fluid balance≤-300 ml for no less than 2 days in the first 3 days after operation(P＝0.021)were the protective factors.[Conclusion]1.The transplanted liver through ischemia-reperfusion in liver transplantation led to a serious systemic inflammatorome syndrome,and led to the occurrence of acute lung injury and the TNF-a and IL-1βinvolved in the occurrence of acute lung injury.2.The experimental part of this study was prompted that the lung injury was obviously serious by the moment of the portal vein open in liver transplantation.If we concentrated on take some measures to alleviate the lung injury at this period, probably will reduce the incidence of postoperative pulmonary complications.3.The clinical part of this study was prompted that compared with the standard classic liver transplantation,the modified classic liver transplantation could significantly reduce the incidence of pulmonary complications after operation.