| Saving organ transplants appear to become the best means of end-stage organ failure, but when faced with the current shortage of bodies for global issues, how to increase the number of donor organs is the primary problem in China is also currently facing international. Currently, cardiac death donor (donor after cardiac death, DCD)has become internationally recognized for one of the three major sources. In China, DCD liver is the main source of donor. But donor inevitably experiences a period of warm ischemia injury, graft ischemic time and perfusion protection methods affect the liver transplantation complications and prognosis. The liver blood circulation blocking cold perfusion start this time, said the warm ischemia time. Total hepatic warm ischemia time in vitro clinical practice is generally believed that not more than5minutes. Some experimental evidence suggests that the liver can withstand the actual warm ischemia time limit up to60minutes. Further explore the liver transplant warm ischemia injury time limits, and how to better protect the donor has important clinical significance. Compare this issue taken the two different rat models of heart, the better to explore "controllable" and "uncontrollable" type donor. One model Salvia miltiorrhiza pretreatment studies Salvia miltiorrhiza donor protection mechanism for liver transplantation, used in traditional Chinese medicine Salvia miltiorrhiza donor liver transplantation in theoretical research and the protection provided experimental evidence. Purpose:The experiment was divided into two parts, the first to examine the difference of graft viabilities in these non-heart-beating donors(NHBD) models by cessation of respiration, availability of liver graft from NHBD in liver transplantation was evaluated. The second part of the application Salvia injection pretreatment slow heartbeat arrest rat model to explore the donor liver transplantation Salvia miltiorrhiza protection mechanisms and experimental evidenceMethods:First experiment:divided30adult male SD rats(weight180-220g) into3groups randomly. The group of control (group A)10, the heart-beating rat was without warm ischemic. Sudden cardiac arrest group (group B)10, by intravenous injection of KCL (0.3g/kg); Slow cardiac arrest group (group C)10, stopped by opening the chest wall. Second experiment:divided20adult male SD rats(weight180-220g) into2groups randomly. The group of control (group D)10, by intravenous injection of saline three days (6g/kg/d) after chest the heart stops beating; Salvia injection treatment group (group E)10, by intravenous injection of salvia three days (6g/kg/d) after chest the heart stops beating. Two experiments were off the graft after Cardiac15min,30min,45min,60min detect venous blood ALT from the inferior vena cava, AST changes, ELISA assay of serum TNF-a, IL-6levels; Second experiment:under the method of xanthing oxidase to test the activity of SOD in the liver tissue; after the blood is completed, take the liver tissue HE staining to observe the morphological changes of liver tissue conditions. Using the system of SPSS17.0to cope with the data and the results are shown in the form of (x±s). Using factor analysis of variance and multiple-group t test to statistical treatment, definite P<0.05is the bound of significant difference.Results:First experiment:In the warm ischemia time points each, B, C groups ALT, AST, TNF-a, IL-6were significantly higher in group A (P<0.05); When off the graft in the heart of30min, B, C groups of ALT and AST were significantly increased, but group B was significantly higher than that in group C, the difference was statistically significant (P<0.05); Group B after warm ischemia TNF-α peaked at30min. while group C60min reaches the maximum value.. Liver morphological changes:In Cardiac inactive60min, B, C groups hepatocytes show edema changed, but group B than in group C was significantly widened sinusoidal. With prolonged warm ischemia,60min liver injury weight of each group in each group30minSecond experiment:D and E groups at30min ALT and AST were significantly higher in the heart Inactive, but increased significantly in group D. IL-6, TNF-a at various points in time warm ischemia D, E groups were elevated, but significantly higher than in group D E group, a significant difference (P<0.05). SOD activity with two prolonged warm ischemia time were increased, but the E group was significantly lower than in group D, a significant difference (P<0.05). Liver morphological changes:When30min, D group than in the E group severe hepatic steatosis, cell ill-defined, lightly stained cytoplasm, nuclear dissolved and disappeared.Conclusion:1.Liver transplantation from NHBD is feasible. The viability of liver graft in slow cardiac arrest was significantly superior to that of in the sudden cardiac arrest model.2. Salvia injection pretreatment can inhibit liver tissue inflammatory cytokines TNF-a and IL-6production, improve the degree of liver damage, reduce heat ischemic liver injury. |
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