Perfusión portal de PGE1 en la fase de revascularización del injerto hepático: estudio de la tolerancia hemodinámica y del efecto sobre la lesión de isquemia-reperfusión en un modelo de trasplante hepático porcino

Abstract

Introduction: Severe ischemia-reperfusion injury (IRI) after liver transplantation are correlated with lower early and late graft and patient survival, higher infection rates, appearance of acute and chronic rejections and other complications. In this field, it has been demonstrated that the prostaglandin E1 (PGE1) presents cytoprotective, anti-inflammatory and vasodilator effects. Therefore, the PGE1 assembles most of the requirements necessary to prevent the development of the ischemia-reperfusion injury, especially if it is administered through via portal vein at full doses in the moment of graft reperfusion.<br/>Materials and methods: Female Largewhite-Landrace pigs (body weight between 30-35 kg) were used. The orthotopic liver transplantation were performed in 18 pairs of pigs. The study was divided into three groups as follows: Control group, 4 experiments of orthotopic liver transplantation with a cold preservation time of 3 hours in Wisconsin solution; Groups A and B, 7 experiments with 24 hours of cold preservation time in each group. Concerning intraportal infusion of medication, the Group B was infused with prostaglandin E1 at a dose of 0.15 ug/kg/min (Alprostadil 500ug) for 90 minutes in the portal reperfusion of the graft; and Group A was infused with saline solution for 90 minutes in the same time period. In the recipient surgery, biochemical (GOT, GPT, LDH, B-Galactosidase, Hialuronic Acid), hemodynamic and histological studies were carried out to evaluate the ischemia-reperfusion injury (IRI).<br/>Results: Survival rate in control group was 100 % and it presented a lower level of sinusoidal-hepatocellular injury and leukocyte activation than the groups A and B. From the beginning of the surgery until the moment of the PGE1 administration, both the group A and the group B were similar in relation to the histology, hepatocellular, endothelial and inflammatory damage markers. After the infusion of the medication (PGE1), the group B developed an increase of the total hepatic flow and a lower alteration of all the parameters of hepatocyte-sinusoidal injury and hepatic function, with an statistical significance in the great majority of them. The portal PGE1 infusion at full doses did not generate hemodynamic instability. <br/>Conclusions: The liver transplantation in pigs with 24 hours of cold ischemia of the graft produced a severe IRI that caused the death of all the animals in the groups A and B due to primary graft nonfunction. Nevertheless, with the intraportal PGE1infusion, the group B presented an increase of the total hepatic flow and a lower alteration of all the parameters of hepatocellular injury, sinusoidal damage and hepatic function. The portal PGE1 perfusion at full doses was well tolerated at hemodynamic level.