실험적 동소성 전 간이식후 이식간의 초기 간 기능 예측 지표에 관한 연구

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 an acceptable therapy for patients with irreversible fiver 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 approximately 10 % of transplant procedures. Possible etiologic factors include liver disease in the donor, technical errors, ischemic injury, and immunologic damage. Ischemic 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 backtable 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 1actate, 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 as just after anesthesia, anhepatic period, 15 minutes, 2 hours, and 6 hours after reperfusion in recipients. Protocol 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 to the result of transplantation.

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 an acceptable therapy for patients with irreversible fiver 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 approximately 10 % of transplant procedures. Possible etiologic factors include liver disease in the donor, technical errors, ischemic injury, and immunologic damage. Ischemic 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 backtable 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 1actate, 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 as just after anesthesia, anhepatic period, 15 minutes, 2 hours, and 6 hours after reperfusion in recipients. Protocol 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 to the result of transplantation.