The Observation Of Liver Graft Injurys By Ischemia And Reperfusion Secondary To Retrograde Reperfusion

Liver transplantation has becomed an effective treatment of a kinds of end-stage liver disease. Poor graft function secondary to injury by ischemia and reperfusion remains a major problem in clinical liver transplantation, At the beginning of the 21st century, Kniepeiss has first reported:the early graft function might be improved,initial nonfuntion(INF) and post-reperfusion syndrome(PRS) might be redueed by method of retrograde via the caval veins in piggyback liver transplantations. However, As a new kind of reperfusion,there were seldom reports on this method about the mechanism of ischemia and reperfusion injury in orthotopic liver transplantations.In this study,the retrograde reperfusion via the caval veins and anterograde reperfusion via portal veins were contrastively studyed. The influence of liver graft injurys by ischemia and reperfusion would be studied in research.Objective Study on the mechanism of liver graft injury by ischemia and reperfusion secondary to retrograde reperfusion in orthotopic liver transplantations.Methods Fifty patients receiving orthotopic liver transplantation were randomly divided into experimental group and control group.Experimental group(25cases) underwent reperfusion with retrograde reperfusions via the caval veins before sequential anterograde reperfusions of portal vein and hepatic artery ,and control group (25cases) received reperfusion with anterograde portal and arterial reperfusion. The ALT, AST,TB, GGT, TNF-αand IL-1 in patients'serum were both tested in the two groups respectively at the time before inferior vena cava occlusion(T1), the time before the inferior vena cava open (T2),the time of the inferior vena cava open in 60 minutes (T3).The graft liver tissue was both check in experimental group and in control group respectively at the time before the inferior vena cava open (t1), the time of the inferior vena cava open in 25 minutes (t2), the time of the inferior vena cava open in 60 minutes (t3). The ratio of hydropic degeneration and necrotic hepatocytes and the percentage of inflammatory cell infiltration were detected under the light microscope and electromicroscope respectively. The graft liver TNF-αand IL-1 positive expression were detected by immunohistochemical.Results①For the operation time,the cold ischemic time,the warm ischemic time, there were no significant difference between the two groups(P > 0.05), the time of inferior vena cava occlusion of the experimental group was shorter than the control group(P <0.05).②For serum ALT, AST,TB,GGT, There were no significant difference between the two groups at T1 and T2(P > 0.05) , but in the experimental group was significant lower than the control group at T3 (P >0.05).③For serum coneentrations of TNF-αand IL-1, there were no significant difference between the two groups at T1(P > 0.05), while the experimental group was remarkably lower than the control group at T2 and T3 (P <0.05).④For the ratio of hydropic degeneration and necrotic hepatocytes and the percentage of inflammatory cell infiltration, there were no significant difference between the two groups at t1(P > 0.05), while the experimental group was remarkably lower than the control group at t2 and t3 (P <0.05).⑤The positive expression of TNF-αand IL-1 was not detected at t1 and t2,while detected at t3 by immunohistochemical ,and the control group was stronger than the experimental group.Conclusions Our experience have demonstrated, that in compared with anterograde reperfusion via the portal vein , not only the injurys caused by isehemia and reperfusion might be redueed by using method of retrograde reperfusion via the caval vein in orthotopic liver transplantations,but also the inflammatory response might be redueed by using method of retrograde reperfusion via the caval vein in orthotopic liver transplantations.