Reperfusion Injury of the Liver and Stomach in Liver Transplant

自由基被认为是肝脏缺血再灌注(I/R)损伤的重要因素之一，并在肝移植后移植物功能不全中起重要作用。细胞因子和前列腺素类物质似乎也是靶细胞产生自由基的重要调节剂，但它们之间的关系尚不清楚。首先，我们分别用化学发光法和体内荧光显微镜研究了大鼠肝脏I/R后白细胞产生自由基和肝脏微循环的变化。然后观察IL-1受体拮抗剂(IL-1ra)和前列腺素E_1(PGE_1)在肝脏I/R中的作用。1)I/R后肝组织学检查未治疗组肝细胞坏死，IL-1ra组肝细胞坏死减轻。对照组大鼠肝上腔静脉血自由基生成量高于肝下腔静脉或门静脉血，而IL-1ra组这一增加被抑制。IL-1ra组大鼠外周血白细胞与肝窦壁的黏附率较高，而IL-1ra组白细胞黏附率较低，白细胞运动较平稳。2)在移植过程中，白细胞运动速度和粘附率与移植物存活率有关。经IL-1ra和PGE1冲洗保存后，移植肾的白细胞运动速度和粘附率提高，移植物存活率提高。结论。IL-1ra和PGE1可减少缺血再灌注肝或移植肝的自由基产生和微循环障碍，从而减轻I/R损伤或提高移植物存活率。

Free radicals are suggested to be one of the most important factors in hepatic ischemia-reperfusion(I/R) injury, and play a major role in primary graft nonfunction after liver transplantation. Cytokines and prostanoids seem to be also important modulators in production of free radicals by target cells, however their relationship is still unclear. First, we investigated the production of free radicals by leukocytes and the microcirculatory changes of the liver after hepatic I/R in rats, using chemiluminescence and in vivo fluolescence microscopy, respectively. And then, we examined the effect of IL-1 receptor antagonist (IL-1ra) and PGE1 in I/R.Second, in liver transplantation model, we studied by the same method as I/R.Results. 1) After I/R, histological examination revealed the liver cell necrosis in no treatment group, but the necrosis was attenuated in IL-1ra group. Free radical production of the blood from suprahepatic vena cava increased compared to infrahepatic vena cava or portal vein in control group, however this increase was suppressed in IL-1ra group. Leukocyte adhesion to the sinusoidal wall was frequetly seen in control group, but in contrast, it was reduced and leukocyte movement was fast and smooth in IL-1ra group. 2) In transplantation , leucocyte velocity and adhesion were correlated with graft survival rate. By rinse and preservation with IL-1ra and PGE1, leucocyte velocity and adhesion, and then graft survival rate were improved. Conclusion. IL-1ra and PGE1 decreased free radical production and microcirculatory disturvances in ischemia-reperfused liver or transplanted liver, and then attenuated the I/R injury or improved the graft survival.