|
KMID : 0391119960050010033
|
|
Ulsan University Medical Journal
1996 Volume.5 No. 1 p.33 ~ p.50
|
|
|
A study of indicators to predict the early graft function after canine orthotopic whole liver transplantation: Analysis of preservation injury seen in protocol biopsy, change of plasma lactate, ammonia and arterial pH
|
|
|
|
|
Abstract
|
|
|
One of the most dramatic advances in the field of liver diseases in the twentieth century is the successful transplantation of the human liver, now on a worldwide scale. With the developments of new surgical techniques, transplantation
immunology,
and
the capability to prevent and to control infections, it has been developed and become and acceptable therapy for patients with irreversible liver diseases.
After transplantation, it is of paramount importance to predict the function of allograft, which affects the result of transplantation and patient's survival. After transplantation, the first two or three days are always characterized by a marked
elevation of transaminase levels and hepatocellular failure.
Poor early graft function(PEGF) has a clinical spectrum characterized by varying degrees of coma and renal failure associated with lactic acidosis, persistent coagulopathy, poor bile production and marked elevations of ALT and AST. The occurrence
of
PEGF is unpredictable; its most severe form, requiring retransplantation and termed primary nonfunction(PNF), is seen following approsimately 10% of transplant procedures. Possible etiologic factors include liver disease I the donor, technical
errors,
ischemic injury, and immunologic damage. Ischemia injury is inherent in the process of organ retrieval, storage, and implantation and is considered as the main factor to contribute to PEGF.
Protocol biopsies of liver allografts obtained during bocktable preparation and 1 to 2 hours after revascularization in the recipients have detailed the sequential histologic events that occur after reperfusion. Once the liver is revascularized,
quick
assessment of its quality from metabolic studies is far more practical than a postperfusion biopsy.
The purpose of this experiment is to observe whether protocol biopsy of allografts(during backtable procedure and 2 hours after revascularization), serum lactate, serum ammonia and arterial pH would be used as the indicators of initial graft
function
after canine orthotopic whole liver transplantation.
The experiment consisted of ten cases of orthotopic whole liver transplantation in mongrel dogs using venovenous bypass. The arterial blood were taken at just after anesthesia, anhepatic period, 15 minutes, 2 hours, and 6 hours after reperfusion
in
recipients. Potocol biopsies of allograft were taken at backtable preparation and 2 hours after reperfusion. We grouped the recipients according to the result of survival time(group A;short survival time group,B;long survival time group) and
according
to the degree of preservation injury(group C;histologically no preservation injury group,D;histologically preservation injury group). And we analysed the change of parameters(serum lactate, ammonia, ALT, AST, arterial pH, histologic finding)
between
group A and B and between group C and D. To evaluate the statistical significance, we used the SAS program and IBM-PC.
In conclusion, we found out that preservation injury seen in protocol biopsy would be one of the indicators to predict the initial function of allograft and the pattern of change of serum lactate and blood ammonia are another possible indicators.
And we
also found out that immediate correction of metabolic acidosis which usually happens just after reperfusion would be related t the result of transplantation.
|
|
|
KEYWORD
|
|
|
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|
|
|