| Objective: Orthotopic liver transplantation (OLT) as a radical means of therapy on the patients of end stage liver failure has made a big progress in our country recently, but compare with the great number of people suffered from this kind of disease , the progress is not enough. The lack of donative liver,high risk of the operation and great expense are the three problems blocking the development of OLT. All of those need us to solve. Almost all of the patients needing to do OLT in our country suffer from posthepatitic cirrhosis, they have portal hypertension and many enlarged portasystemic collaterals. Because of this , the OLT without venovenous bypass whose operation is simpler relatively and whose expense is less relatively , is more suitable to be used in our country. However, with the absence of venovenous bypass during one hour of anhepatic phase, there will be an ischemia/reperfusion renal injury. It is very useful for the clinic doctor to know the changes of renal structure and function after such an injury. In this study, we investigated the renal injury of portal hypertension rat after one hour of anhepatic phase, aimed at finding the character and mechanism of renal injury and its course of recovery , provided reference for clinic treatment. Methods: One hundred and thirty-five healthy male Wistar rats, weight 250~300g, were used. 15 rats were taken randomly as normal control group(NC), The recoverable prehepatic portal hypertensive model were induced on other rats. Three weeks later, 15 model rats were taken randomly as portal hypertensive control group(PHC), the other 105 model rats had another operation and then were divided randomly into 0,6h,12h,24h,48h,72h,7d group according to different reperfusion time after the occlusion of hepatic portal and vena cava below the liver. Each group contained 15 rats. Portal pressure were measured and splenoportogram were performed on normal and portal hypertensive control group. At the respectively time points after reperfusion the examinations below were done:blood were obtained to determined ALT,AST,TBIL, BUN,Cr concentrations；morphological changes of liver and kidney were observed under optical microscopy,the ultrastructure of renal tissue were examined by transmission electron microscopy also；the changes of SOD and MDA concentrations of renal tissue were studied. All data of test were analyzed by statistic software.Results: Ascites and enlarged vessels of viscera could be seen in the PHC group,but the color and texture of liver were normal. The portal pressure of PHC group was 15.6±3.1mmHg,almost doubled that of NC group(7.7±1.7mmHg),and the difference was significant (P<0.05). When the labeled tube was removed,the portal pressure was 13.4±2.3mmHg,which was significantly higher than that of NC group(P<0.05),but there was no difference compared with that of PHC group(P>0.05). The splenoportogram showed,in PHC rats ,the opacity of liver was slow,and a stenosis could be seen at the portal vein trunk proximal to the bifurcation, the vessels of portal system twisted and dilated,the enlarged collateral veins such as left abrenal gland vein and azygos vein could be seen,the superior and inferior vena cava through the portosystemic shunts were opcified,the stenosis of portal vein disappeared after labeled tube was removed；but there were no shunt between portal and venacaval system in NC rats. The area of esophageal submucosal vein of NC group and PHC group were 5.6200±1.3010um2 and 33.5820±6.4250um2 respectively,the difference was significant(P<0.05)。The mean arterial pressures were 92±5.2 mmHg,56.3±2.8 mm and 70.6±4.2mmHg before occlusion,occlusion and after occlusion of hepatic portal and inferior vena cava respectively. The main injuries of kidney after ischemia/reperfusion were located in tubular epithelial cell,the injuries in the junction of cortex and medulle were much severer than that in cortex and medulle,while the lesion of glomerulus were not significant. Microscopy examination show... |
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