Abstract
Objective To study the influence of sequential and contemporaneous revascularizations of portal vein and hepatic artery during liver transplantation with retrograde reperfusion on the ultra-structural changes in intrahepatic cholangiocytes of the graft with liver ischernia reperfusion injury, and the recovery of short-term liver function after operation. Methods The clinical data of 97 patients who underwent orthotopic liver transplantation (OLT) using retrograde reperfusion via the vena cava (IVC) in our hospital from January, 2009 to June, 2013 were retrospectively analyzed. Using to the different sequences of revascularization, 97 eligible patients were divided into three groups: group R-IPR: the initial arterial revascularization group (35 patients); group R-IAR: the initial portal revascularization group (30 patients); group R-SAPR: simultaneous reperfusion group (32 patients). Liver function, coagulation function and other related parameters were continuously monitored for the transplant recipients at the following time points: 1 day before operation, 2 hours after reperfusion and on postoperative Day 1, 2, 5 and 7. The ultra-structure of intrahepatic bile duct epithelial cells at 2 hours after reperfusion were studied by transmission electron microscopy and morphometric analysis of mitochondria was performed by the computer image analysis system. Results The levels of ALT, GGT and TB in group R-IAR were significantly lower than those in group R-IPR and group R-SAPR (P 0.05). In group R-IAR and group R-IPR, mitochondrial swelling of bile duct epithelial cells was more severe than that in group R-SAPR. There were significant differences among the three groups in the mitochondrial average area and the average perimeter (P 0.05). Mitochondrial swelling of hepatic cells was most severe in group R-SAPR. There were significant differences in the average area and average perimeter of hepatic cell mitochondria between group R-SAPR and the other two groups (P<0.05). Conclusion During liver transplantation with retrograde reperfusion, initial arterial revascularization reduced the short-term levels of transaminases, improved early liver function after operation and protected the intrahepatic bile duct against the second ischemia reperfusion injury. Key words: Orthotopic liver transplantation; Retroperfusion; Sequence of revascularization; Ischemia /reperfusion injury; Liver function; Cell ultrastructure
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