Clinical Experimental Study Of Improved Orthotopic Liver Transplantation Retroperfusion

Currently the treatment of liver transplantation is applied to liver diseases,including liver cancer,middle and advanced liver cirrhosis,serious hepatitis,congenital and metabolic liver diseases and the like,which has made a series of breakthroughs,especially as the final and effective methods for treatment of severe acute liver failure.However,the ischemia reperfusion injury to donor liver during liver transplantation is difficult to avoid.The injury has a major impact on postoperative primary graft non-function and complications. How to reduce ischemia reperfusion injury in liver transplantation is one of the hot topics in clinical liver transplantation.Kniepeiss first reported in 2003 that,adopted by the postcava retrograde perfusion may improve early graft function and reduce postoperative reperfusion syndrome.As an improved surgical approach,the improved retrograde perfusion is reported little in orthotopic liver transplantation surgery.In the study,we intend to reduce ischemia-reperfusion injury to the graft through improved orthotopic liver transplantation retroperfusion, which may discharge metabolic harmful substances caused by cold ischemia of donor liver and retrograde perfusion rewarming as early as possible during the operation,so that the liver function may be improved early and internal environment disturbance of the body is minimized.We match the results with data of patients by traditional retrograde perfusion,in propensity score matching(PSM),balance concomitant variable impact among groups, and conduct comparative study on patients matched,to investigate postoperative function impact to graft after improved retrograde perfusion.Part 1 Research of Reducing Injury Caused during Liver Transplantation by Improved Method of Orthotopic Liver Transplantation Retrograde PerfusionObjective To investigate the influence on transplanted liver injury by improved method of orthotopic liver transplantation retrograde perfusion.Methods Use improved method of orthotopic liver transplantation retrograde perfusion on 21 liver disease patients.Observation time: The moment before transplanted liver opening postcava(T1),the moment after postcava opening postcava blood retrograde perfusion for 10 ml bleeding of hepatic portal vein(T2),the moment after postcava blood retrograde perfusion for 50 ml bleeding of hepatic portal vein(T3) and the moment after postcava blood retrograde perfusion for 200 ml bleeding of hepatic portal vein(T4).Abstract postcava blood of the receptor at T1 and postcava blood retrograde perfusion for retrograde perfusion blood of hepatic portal vein at T2,T3 and T4.Conduct biochemical test and blood gas analysis for the blood samples and compare change of venous blood p H values,Pa CO2,Pa O2,BEecf,HCO3-,T-CO2,Sa O2,alanine aminotransferase(ALT),glutamyl endopeptidase(GGT),K +,alkaline phosphatase(AKP) and aspartate aminotransferase(AST) at different time,to observe the change after postcava blood is perfused retrogradely to the donor liver.Results The values of blood gas analysis pH value,PaCO2,PaO2,BEecf,HCO3-,T-CO2 and Sa O2,from venous blood abstracted from 21 patients,show large fluctuation at T2 and T3.Compared with T1 and T4,the difference is statistically significant(P <0.05).The values at T4 tend to return to the level at T1,among which HCO3- and T-CO2 at T4 return to level at T1,with statistically significant difference(P> 0.05); p H value,Pa O2,Beecf and Sa O2 are higher than that at T1,without statistically significant difference(P <0.05); and Pa CO2 is less than that at T1,with statistically significant difference(P <0.05).Biochemical tests for abstracted blood show that,from T1 to T4,ALT,AST,AKP and K + rise to the highest point at T2,then gradually decline to the bottom at T4,which are still higher than that at T1.For comprison of any two points among T1,T2,T3 and T4,the difference is statistically significant(P <0.05).GGT rises at T2 and T3 and falls back at T4,which is lower than that at T1.For respective comparison of T2 and T3 with T1 and T4,the difference is statistically significant(P <0.05) and for comparison of T1 with T4,the difference is not statistically significant(P> 0.05).Conclusion Postcava blood retrograde perfusion during orthotopic liver transplantation may rapidly reduce ischemia reperfusion injury to the tranplanted liver and stabilize internal environment.Part 2 Study of Improved Retrograde Perfusion Technique during Liver TransplantationObjective To investigate the postoperative impact on graft in improved retrograde perfusion of classic orthotopic liver transplantation technique(improved retrograde perfusion).Methods Collect liver transplantation operation data of 108 patients from March 2011 to September 2014,of which 63 patients use retrograde perfusion operation treatment during classic orthotopic liver transplantation and 45 use improved retrograde perfusion.Use propensity score matching(PSM) to balance concomitant variable impact among groups,get patients matched,and analyze postoperative liver function recovery.Results After the PSM,we get 27 pairs of patients.After matching,we can see that the differences of alkaline phosphatase(AKP),total bilirubin(TB),alanine aminotransferase(ALT),gamma glutamyl transpeptidase(GGT) and aspertate aminotransferase(AST) of liver function(day 1,day 3,day 5 and day 7 after operation),between improved retrograde perfusion during classic orthotopic liver transplantation and retrograde perfusion,are statistically significant(P <0.05).Conclusion With the improved retrograde perfusion during classic orthotopic liver transplantation,the early graft function is improved.Besides,it accelerates the recovery of liver function,and thus improve overall curative effect of liver transplantation.