摘要
目的 本研究旨在探讨无缺血肝脏移植（Ischemia-free liver transplantation,IFLT）技术在临床应用的可行性及安全性.方法 在大量动物实验基础上创立了IFLT技术并应用于临床.通过分析2017年7—8月间接受IFLT手术的3例供、受者资料,对其手术方法进行总结,记录肝脏灌注参数及血气生化指标,监测术后早期肝功能恢复及并发症的情况,收集供肝获取前、灌注终点和复流后的组织标本行病理检查,了解肝脏的缺血再灌注损伤情况.结果 3例终末期肝病患者接受了IFLT,在供肝获取、体外保存和植入受者过程中均保持供肝血流供应不中断.机械灌注液中的pH值稳定在7.30～7.47,血乳酸均在灌注1.5～3 h后下降至＜0.3 mmol/L.灌注过程中胆汁持续产生,每小时2～6ml.HE染色及TUNEL检测均显示,供肝获取前、灌注终点及复流后没有明显的肝细胞坏死和凋亡.白细胞介素1β（IL-1β）和血管性血友病因子（von Willebrand Factor,vWF）免疫组化检测显示,肝组织未见明显炎症因子释放和血管内皮激活.术后1周3例受者的转氨酶均降至正常,术后丙氨酸转氨酶峰值为120～465 U/L,无排斥反应、血管和胆道并发症发生,3例受者已顺利出院.结论 WLT是一种安全、有效的新技术,可望克服传统肝移植技术的诸多缺点,成为未来肝移植的主流技术之一.
Objective Ischemia reperfusion injury （IRI） is a major limiting factor of graft survival in organ transplantation.We＇ve established a novel procedure called ischemia-free liver transplantation （IFLT） in big animal study.In this report,we aimed to investigate the feasibility and early outcomes of IFLT.Methods We have performed 3 cases of IFLT during July 23,2017 to August 9,2017.We analyzed the surgical methods,normothermic perfusion parameters,blood gas analysis,liver function tests and complications early after liver transplantation.Pathologic studies and immunohistochemical staining of donor liver biopsies were conducted before procurement,at the end of machine perfusion,as well as after re-vascularization for evaluating IRI.Results The surgical procedures of all 3 patients were successful,without stoppage of blood supply for the liver grafts throughout organ procurement,ex vivo preservation and implantation.During normothermic perfusion,the pH value was stable within the normal range and the lactate levels dropped quickly to lower than detected （〈0.3 mmol/L） within 1.5-3 h.The livers continued to produce bile with the volume of 2-6 mL/h.Hematoxylin and eosin （HE） staining evaluation and TdT-mediated dUTP nick end labeling （TUNEL） assay of biopsies taken from liver tissues before procurement,at the end of machine perfusion and after re-vascularization,showed few necrostic and apoptotic hepatocytes in the liver biopsies.The immunohistochemical staining of IL-1β and vWF suggested no inflammatory cytokine release and sinusoidal endothelial cell activation.The three patients recovered smoothly without rejection,vascular and biliary complications.Conclusion IFLT is a feasible and effective procedure,which is able to overcome the major limitations of conventional procedure.The novel IFLT will become one of the mainstream transplant procedures in the future.
出处
《中华器官移植杂志》
CAS
CSCD
2017年第10期577-583,共7页
Chinese Journal of Organ Transplantation
基金
国家自然科学基金面上项目（81373156,81471583）
公益性行业科研专项基金（201302009）
国家临床重点专科建设项目
广东省器官捐献与移植免疫重点实验室建设项目（2013A061401007）
广东省器官移植国际合作基地（20158050501002）
关键词
无缺血肝脏移植
缺血再灌注损伤
常温机械灌注
早期预后
ischemia and reperfusion injury
normothermic machine perfusion
ischemia-free liver transplantation
early prognosis
