Estimation of Graft Viability before Reperfusion Using Hepatic Microdialysate Hypoxanthine Levels in Porcine Liver Transplantation from Non-Heart-Beating Donors

无心跳供体（NHBDs）被认为是原位肝移植（OLTX）的移植物，但由于原发性无功能的频率高，还不能接受。为了建立成功的肝移植，需要新的策略。本研究的目的是探讨在心脏停搏供体热缺血期间监测肝脏微透析液次黄嘌呤水平对评估移植前肝脏活力的有用性。猪OLTX使用从原位热缺血（0，30和60分钟）的NHBD获得的移植物进行。在供体手术中，通过微透析方法测量热缺血期间肝间质次黄嘌呤水平。所有0 min组、30 min组13头猪中的6头和60 min组4头猪中的1头均存活超过7天。次黄嘌呤水平的显着增加被视为依赖于热缺血时间。在30分钟组中，次黄嘌呤水平显着高于那些幸存的猪死亡，并与受体的腺苷三磷酸，天冬氨酸转氨酶，乳酸脱氢酶水平。组织学检查显示，次黄嘌呤水平较高的猪移植物损伤严重。心脏骤停供体中次黄嘌呤的显著间质形成可能表明热缺血损伤的程度，再灌注后自由基增加的间接证据，或腺苷酸池的大量损失。这些观察结果表明，肝微透析液次黄嘌呤水平在热缺血NHBDs与肝移植前的生存能力，预测移植物的生存能力可能是可能的，通过使用这种方法。

Non-heart-beating donors (NHBDs) are being considered for grafts in orthotopic liver transplantation (OLTX), but are not yet acceptable because of the high frequency of primary nonfunction. To establish successful liver engraftment, new strategies are needed. The aim of this study was to explore the usefull of monitoring hepatic microdialysate hypoxanthine levels during warm ischemia in cardiac arrest donors to assess liver viability before transplantation. Porcine OLTX was performed using grafts obtained from NHBDs subjected to in situ warm ischemia (0, 30 and 60 min). In the donor operation, hepatic interstitial hypoxanthine levels were measured during warm ischemia by a microdialysis method. All of the 0-min group, 6 of 13 pigs in the 30-min group, and 1 of 4 pigs in the 60-min group survived more than 7 days. Significant increases of hypoxanthine levels were seen dependent on warm ischemic time. In the 30-min group, hypoxanthine levels were significantly higher in the pigs that died than in those that survived, and correlated with the adenosine triphosphate, aspartate aminotransferase, and lactate dehydrogenase levels of recipients. Histological examination revealed that graft injury was severe in the pigs with higher hypoxanthine levels. Marked interstitial formation of hypoxanthine in cardiac arrest donors may indicate the degree of warm ischemic injury, indirect evidence of increased free radicals after reperfusion, or a substantial loss of the adenylate pool. These observations suggest that hepatic microdialysate hypoxanthine levels during warm ischemia in the NHBDs were correlated with liver viability before transplantation and that prediction of the viability of the graft may be possible by using this method.