Synergistic effect of cold and warm ischemia time on postoperative graft function and outcome in human liver transplantation
Synergistic effect of cold and warm ischemia time on postoperative graft function and outcome in human liver transplantation
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DOI：
10.1016/j.transproceed.2004.08.068
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发表时间：
2004-09-01
影响因子：
0.9
通讯作者：
Sasaki, M
中科院分区：
文献类型：
--
作者：
Totsuka, E;Fung, JJ;Sasaki, M
据报道，原位肝移植（OLT）术后移植物功能障碍的主要原因是移植物保存期间的冷缺血时间（CIT）和复温期间的热缺血时间（WIT）延长。然而，CIT和WIT联合使用对患者和移植物存活的影响尚未明确。本研究的目的是确定同时延长的CIT和WIT是否与临床OLT后早期移植物结果相关。为分析肝移植术后90天内肝移植存活及术后移植物功能，将186例连续肝移植患者分为4组：A组，CIT < 12小时，WIT < 45分钟；B组，CIT bb0 12 h, WIT < 45 min；C组，CIT < 12 h, WIT bb0 45 min；D组，CIT > 12小时，WIT > 45分钟。A组、B组、C组和D组的移植物损失率分别为5.4%、9.8%、11.1%和42.9%。移植后平均最高的天冬氨酸转氨酶（AST）值D组（3352.3 +/- 569.4 U/L）显著高于A组（1411.7 +/- 169.2 U/L）和B组（1931.3 +/- 362.6 U/L）。同时延长的冷缺血和热缺血时间明显导致同种异体肝移植损伤和衰竭，提示CIT和WIT对术后移植功能有一定的累积作用。
Prolonged cold ischemia time (CIT) during graft preservation and warm ischemia time (WIT) during rewarming time have been reported to cause postoperative graft dysfunction after orthotopic liver transplantation (OLT). However, the effects of both CIT and WIT in combination on patient and graft survivals are not yet defined. The aim of this study was to determine whether simultaneously prolonged CIT and WIT were associated with early graft outcomes after clinical OLT. For analysis of liver graft survival within 90 days of OLT and postoperative graft function, 186 consecutive OLT cases were divided into four groups as follows: group A, CIT < 12 hours and WIT < 45 minutes; group B, CIT > 12 hours and WIT < 45 minutes; group C, CIT < 12 hours and WIT > 45 minutes; and group D, CIT > 12 hours and WIT > 45 minutes. The graft loss rates were 5.4% in group A, 9.8% in group B, 11.1% in group C, and 42.9% in group D. The mean highest aspartate aminotransferase (AST) value after OLT in group D (3352.3 +/- 569.4 U/L) was significantly greater than those in groups A (1411.7 +/- 169.2 U/L) and B (1931.3 +/- 362.6 U/L). The simultaneously prolonged cold and warm ischemia times significantly caused hepatic allograft injury and failure, suggesting some cumulative effects of CIT and WIT on postoperative graft function.