Role of hypotension in brain-death associated impairment of liver microcirculation and viability

被引:14
作者
Okamoto, S [1 ]
Corso, CO [1 ]
Leiderer, R [1 ]
Rascher, W [1 ]
Yamamoto, Y [1 ]
Yamaoka, Y [1 ]
Messmer, K [1 ]
机构
[1] Wakayama Med Ctr, Japanese Red Cross Soc, Dept Surg 1, Wakayama 6408269, Japan
关键词
liver transplantation; brain death; organ donor; hypotension; hepatic microcirculation; graft viability;
D O I
10.1007/s001470050725
中图分类号
R61 [外科手术学];
学科分类号
摘要
Hypotension in brain-dead organ donors is considered a determinant factor of graft viability. The aim of this study was to elucidate the role of hypotension in brain-death associated impairment of hepatic microcirculation and function. Male Sprague-Dawley rats with an intracranial balloon were used. Group I (n = 7) served as sham controls. In group ZI (n = 7) brain death was induced through inflation of an intracranial balloon. In group III (n = 7) hypotension without brain death was induced by means of pentobarbital. In group II, a steep rise of arterial pressure was followed by a fall to a lower level (P < 0.01, vs. group I). Also in group III arterial pressure was lower (P < 0.01, vs. group I). In group II, bile production was diminished (P < 0.05). Impaired sinusoidal perfusion (P < 0.01) and enhanced leukocyte endothelium interaction (P < 0.05) were documented in hepatic microvasculature. Electron microscopic analysis revealed vacuolization of hepatocytes; these changes were not observed in group III. Brain death induces specific changes of liver microcirculation, function and histomorphology. Independent of associated hypotension, brain death per se impairs donor liver graft quality.
引用
收藏
页码:428 / 435
页数:8
相关论文
共 34 条
[1]   THE USE OF MARGINAL DONORS FOR ORGAN-TRANSPLANTATION - THE INFLUENCE OF DONOR AGE ON OUTCOME [J].
ALEXANDER, JW ;
VAUGHN, WK .
TRANSPLANTATION, 1991, 51 (01) :135-141
[2]   BLOOD-LEVELS OF CYTOKINES IN BRAIN-DEAD PATIENTS - RELATIONSHIP WITH CIRCULATING HORMONES AND ACUTE-PHASE REACTANTS [J].
AMADO, JA ;
LOPEZESPADAS, F ;
VAZQUEZBARQUERO, A ;
SALAS, E ;
RIANCHO, JA ;
LOPEZCORDOVILLA, JJ ;
GARCIAUNZUETA, MT .
METABOLISM-CLINICAL AND EXPERIMENTAL, 1995, 44 (06) :812-816
[3]   THE EFFECTS OF BRAIN-DEATH ON CARDIOPULMONARY HEMODYNAMICS AND PULMONARY BLOOD-FLOW CHARACTERISTICS [J].
BITTNER, HB ;
KENDALL, SWH ;
CHEN, EP ;
CRAIG, D ;
VANTRIGT, P .
CHEST, 1995, 108 (05) :1358-1363
[4]   BILE-FLOW - AN INDEX OF ISCHEMIC-INJURY [J].
BOWERS, BA ;
BRANUM, GD ;
ROTOLO, FS ;
WATTERS, CR ;
MEYERS, WC .
JOURNAL OF SURGICAL RESEARCH, 1987, 42 (05) :565-569
[5]   Hormonal and hemodynamic changes in a validated animal model of brain death [J].
Chen, EP ;
Bittner, HB ;
Kendall, SWH ;
VanTrigt, P .
CRITICAL CARE MEDICINE, 1996, 24 (08) :1352-1359
[6]   APPROACH TO MANAGEMENT OF THE HEARTBEATING BRAIN-DEAD ORGAN DONOR [J].
DARBY, JM ;
STEIN, K ;
GRENVIK, A ;
STUART, SA .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1989, 261 (15) :2222-2228
[7]   INDUCTION OF PLASMA INTERLEUKIN-6 BY CIRCULATING ADRENALINE IN THE RAT [J].
DERIJK, RH ;
BOELEN, A ;
TILDERS, FJH ;
BERKENBOSCH, F .
PSYCHONEUROENDOCRINOLOGY, 1994, 19 (02) :155-163
[8]  
EMERY RW, 1986, ANN THORAC SURG, V41, P356, DOI 10.1016/S0003-4975(10)62686-0
[9]  
FRAGEN RJ, 1994, ANESTHESIA, P229
[10]   SERUM AND TISSUE T3-LEVELS IN ENDOTOXIN-SHOCK IN THE RAT [J].
GORETZKI, PE ;
CAVALIERI, RR ;
WAHL, RA ;
ELLIS, RJ ;
MCMAHON, FA ;
GOLDFIEN, S ;
GEREND, P ;
CLARK, OH .
JOURNAL OF SURGICAL RESEARCH, 1983, 35 (03) :211-217