Einfluss diverser Reperfusionsarten auf den Ischämie-/ Reperfusionsschaden nach orthotoper Lebertransplantation im Rattenmodell Retrograde reperfusion via the vena cava inferior reduces ischemia-/ reperfusion injury after orthotopic liver transplantation in a rat model

Introduction: graft dysfunction after liver transplantation due to ischemia-/reperfusion injury remains a serious clinical problem although there is a marked progress in transplantation medicine. The aim of this experimental study was to compare different types of reperfusion with regard to the ischemia-/ reperfusion injury. Materials and Methods: arterialised orthotopic liver transplantation (OLT) was performed in syngenic male Lewis rats. The animals were devided into 3 experimental groups: I- and II-control groups with antegrade reperfusion, III-retrograde reperfusion group. Laboratory parameters as well as histopathologic changes of the graft were evaluated 1, 24 and 48 hours after the OLT. Results: 24 hours after the OLT the GOT-values showed a significant difference between groups with antegrade/retrograde variant of reperfusion (2613,3 ± 343,9 U/l vs. 1186,4 ± 252,9 U/l; p < 0,001). The GPT- and GOT-values were significanly lower in the group III 48 hours after OLT. The histopathologic evaluation revealed a significantly lower number of necrotic areas in the group III compared to the control-groups (p < 0,002). Conclusion: our results show that the retrograde reperfusion (from the infrahepatic V. cava inferior with opening of the blood stream to the supra-hepatic V. cava inferior and to the Vv. hepaticae retrograde to the liver) has a protective effect on the graft. Einleitung Eine Transplantatdysfunktion nach klinischer Lebertransplantation durch den Ischamie-/Reperfusionsschaden stellt trotz der Fortschritte der Transplantationsmedizin immer noch ein ernsthaftes klinisches Problem dar [1]. Ferner kommt es aufgrund der herrschenden relativen Organknappheit bei der »high urgency-Listung« der Patienten zur Akzeptanz auch qualitativ marginaler Organe, die besonders sensibel auf die Schadigung durch die Ischamie-/Reperfusion reagieren. Daher war das Ziel dieser tierexperimentellen Studie den Einfluss diverser Reperfusionsarten auf den Ischamie-/Reperfusionsschaden quantitativ histopathologisch und laborchemisch zu evaluieren. Methodik Zur orthotopen arterialisierten Lebertransplantation in standardisierter Technik wurden (zum Ausschluss einer Abstosungsreaktion) syngene ingezuchtete mannliche LEWIS-Ratten (RT1 1 )v er