冷缺血时间对肝移植术后早期移植物功能及排斥反应的影响

Effect of cold ischemia time on early graft function and acute rejection after liver transplantation

    摘要
  • 摘要:
      目的  探讨不同冷缺血时间(CIT)对肝移植术后早期移植物功能和急性排斥反应(AR)的影响。
      方法  收集并分析218例肝移植供、受者的临床资料, 按照供肝CIT分为A组(CIT≤6 h, 60例)、B组(6 h < CIT≤10 h, 89例)、C组(CIT > 10 h, 69例)3组。收集受者术后1、7、14 d的血液样本, 检测丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、乳酸脱氢酶(LDH)、CD4+T细胞三磷酸腺苷(ATP)的变化情况。分析术后各组受者的AR发生率和C4d沉积阳性率。
      结果  各组ALT、AST和LDH水平在术后1 d即达到峰值, 随后逐渐下降, 至14 d各组各指标相当, 且术后时间与组别均存在交互效应。肝移植术后各组CD4+T细胞ATP水平逐渐上升, 至术后7 d达到峰值, 然后逐渐下降, 且术后时间与组别均存在交互效应。A、B、C 3组AR发生率分别为10%、12%、28%;与C组比较, A、B组的AR发生率明显降低(均为P < 0.05/3)。A、B、C组AR受者的C4d沉积阳性率分别为1/3、45%、89%;与C组比较, A组的C4d沉积阳性率明显降低(P=0.015)。
      结论  CIT延长有可能导致肝移植术后早期肝功能损伤加重, 更易诱发体液性AR。

     

    Abstract:
      Objective  To evaluate the effect of different cold ischemia time (CIT) on early graft function and acute rejection (AR) after liver transplantation.
      Methods  Clinical data of 218 donors and recipients undergoing liver transplantation were collected and analyzed. All patients were divided into three groups according to the CIT of donor liver: group A (CIT≤6 h, n=60), group B (6 h < CIT≤10 h, n=89) and group C (CIT > 10 h, n=69). Blood samples were collected on the 1, 7 and 14 d after liver transplantation. The changes of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and adenosine triphosphate (ATP) in CD4+T cells were detected. The incidence of AR and the positive rate of C4d deposition were analyzed.
      Results  The ALT, AST and LDH levels in each group reached the peak on the 1 d after operation, and then gradually decreased. The indexes in each group were almost equivalent on the 14 d. An interaction effect existed between postoperative time and group. After liver transplantation, ATP levels in CD4+T cells were gradually increased in each group, peaked at postoperative 7 d, and then decreased gradually. An interaction effect was noted between postoperative time and group. The incidence of AR in groups A, B and C was 10%, 12% and 28%. Compared with group C, the incidence of AR in groups A and B was decreased significantly (both P < 0.05/3). The positive rate of C4d deposition in AR recipients of groups A, B and C was 1/3, 45% and 89% respectively. Compared with group C, the positive rate of C4d deposition in group A was decreased significantly (P=0.015).
      Conclusions  The prolongation of CIT may lead to aggravation of early-stage liver function injury after liver transplantation, which is more easily to induce humoral AR.

     

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