Objective To evaluate the effect of warm ischemia time of donor liver from donation after cardiac death (DCD) on transplant liver in rats.
Methods The rat models of orthotopic liver transplantation of DCD donor liver were established.According to the time of cardiac arrest before obtaining the donor livers, 54 recipient rats were evenly divided into three groups:control group (W0 group, no warm ischemia, n=18), 10 min warm ischemia group (W10 group, n=18) and 20 min warm ischemia group (W20 group, n=18).At 1, 3, and 7 d after operation, serum liver function alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were quantitatively measured in rats of each group, liver cells and its organelles were observed by electron microscopy and the expression levels of cytochrome C (Cyt C) and apoptosis inducing factor (AIF) proteins in liver tissues were detected by Western blot in rats of each group.
Results The serum levels of ALT and AST in each group were significantly increased at 1 d after liver transplantation along with the prolongation of warm ischemia time.Compared with the W0 group, the serum levels of ALT and AST in the W10 and W20 groups were increased significantly (all P < 0.05).At postoperative 3 d, the serum levels of ALT and AST in each group were slightly decreased.Compared with the W0 group, the serum levels of ALT and AST in the W10 and W20 groups were significantly higher (all P < 0.05).At 7 d after operation, the serum levels of ALT and AST in each group were elevated again.Compared with the W0 group, the serum levels of ALT and AST in the W10 and W20 groups were remarkably increased (all P < 0.05).Electron microscope showed that along with the prolongation of warm ischemia time, the degree of hepatocyte edema was gradually aggravated, the endoplasmic reticular expansion was steadily increased and the degree of mitochondrial damage was aggravated, especially in the W20 group.At postoperative 1 d, the expression level of AIF and Cyt C proteins in the liver tissues did not significantly differ among three groups (all P > 0.05).At 3 and 7 d after operation, compared with the W0 group, the expression levels of AIF and Cyt C proteins were significantly up-regulated in the W10 and W20 groups (all P < 0.05), and the expression levels of AIF and Cyt C proteins in the W20 group were significantly higher than those in the W10 group (both P < 0.05).
Conclusions The warm ischemia of the DCD donor liver mainly leads to liver cell injury.Along with the extension of warm ischemia time, significant changes occur in the morphology of mitochondria and other organelles and the expression level of mitochondrial apoptosis-related proteins in transplanted liver cells.
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