Animal Experiment And Clinical Study On Oxidative Stress Injury Of Transplanted Liver By Inverse Perfusion

Objective this study was divided into two parts: 1.To observe the effect of retrograde perfusion of inferior vena cava on oxidative stress molecules and inflammatory factors in liver transplantation by establishing a rat model of allograft orthotopic liver transplantation;2.A retrospective study was conducted on the preoperative and postoperative indicators of patients undergoing central liver transplantation to observe the effect of retrograde perfusion of inferior vena cava in orthotopic liver transplantation on the donation after cardiac death devoted(DCD-devoted)early oxidative stress injury.Method: Part 1:130 male Sprague-Dawley(SD)rats were randomly divided into 7 groups: control group,1-hour initial portal vein reperfusion(IPR)group,2-hour IPR group,6-hours IPR group,1-hour retrograde reperfusion via inferior vena cava(RETR)group,2-hour RETR group,6-hours RETR group.Control group reference for liver surgery way,IPR and RETR group implement allograft orthotopic liver transplantation,among which utilizes the IPR portal vein perfusion method,RETR group by using inverse perfusion via the inferior vena cava.In the control group,serum was collected before the liver was taken for detection of tumor necrosis factor-?(TNF-?)and high mobility group protein B1(HMGB1),and liver tissue was retained for detection of superoxide dismutase(SOD)and malonaldehyde(MDA).Serum was collected from the portal vein group and the reverse perfusion group at 1,2,and 6 hours after perfusion for detection of TNF-?and HMGB1,and liver tissue was collected for SOD and MDA.Part 2: a total of 48 patients who underwent liver transplantation in our center from January 2018 to September 2019 were collected.According to the different surgical methods,they were divided into IPR group(23 cases)and RETR group(25 cases).Observation under the different operation methods two groups of patients were age,sex,MELD score,as well as postoperative 1 day,2 days,3 days,5 and 7 days in serum alanine aminotransferase(ALT),aspertate aminotransferase(AST),prothrombin time(PT),GGT(gamma glutamyl transpeptidase)(GGT),serum albumin(ALB)and total bilirubin(TB)recovery,and detection for clinical liver perfusion before and after infusion of SOD and MDA content in liver tissue.Results part I: the SOD level of IPR group was significantly lower than RETR group(F=16.581,P= 0.001),and the SOD level was also significantly lower than RETR group at each postoperative time point(P < 0.05).The postoperative MDA level of IPR group was significantly higher than RETR group(F=13.884,P=0.002),and the MDA level at each postoperative time point was also significantly higher than RETR group(P < 0.05).The level of TNF-? in IPR group was significantly higher than RETR group(F=12.88,P=0.002),and the level of TNF-? in each postoperative time point was significantly higher than t RETR group(P < 0.05).HMGB1 level in IPR group was significantly higher than RETR group(F=30.246,P=0.000),and there was an interaction effect between the two groups.HMGB1 level 1 and 2 hours after surgery was significantly higher than RETR group(P < 0.05),and there was no significant difference between the two groups 6 hours after surgery(P > 0.05).The maximum value was 2 hours after surgery in IPR group,while the minimum value was 6 hours after surgery in RETR group.The second part: in the level of ALT,AST,TB,IPR group was significantly higher than RETR group(P < 0.05).The ALT and TB levels in each time after surgery,IPR group were significantly higher than RETR group(P < 0.05).AST level in the first day,there was no significant difference in the two groups(P > 0.05),and the rest of the time the IPR group were significantly higher than RETR group(P < 0.05).At the levels of ALB,GGT and PT,there was no significant difference between the two groups(P >0.05),and there was no significant difference between the two groups(P >0.05)in the comparison of postoperative time points.There was no significant difference in SOD and MDA levels between IPR group and RETR group before surgery(P >0.05),but the post-perfusion SOD level of IPR group was significantly lower than RETR group(P < 0.05),while the post-perfusion SOD level of IPR group was significantly higher than RETR group(P < 0.05).Conclusion 1.Retroperfusion through the inferior vena cava can reduce the levels of oxidative stress molecules and inflammatory factors after transplantation.2.Retroperfusion through inferior vena cava can reduce the early oxidative stress injury after DCD-derived liver transplantation.