Study On Liver Graftes Biliary Of Different Cold Ischemia Time Injured By Second Warm Ischemia

Objective: To explore the structural change of biliary epithelia and the transmutation of liver function affected by second warm ischemia time' s injurying on different CIT, which presenting theoretical basic of conserving liver as well as definiting the sequences of opening portal vein and hepatic artery in liver transplantation.Materials and Methods: 30 cases undergoing OLT of different CIT were distributed to A or B group. A group included 18 patients whose CIT was less than 12hr, and B group included 12 patients whose CIT was longer than 12hr. The samples of external hepatic bile duct was divided into two parts, the first was part of pre- ischemia of bilary tissue and the second was part of bilary tissue of pre-reperfusion due to hepatic artery openning. We detected the change of biliary epithelia structure by common microscope and electron microscope. At the same time ALT, TBIL and γ—GT were tested on postoperative 1, 2, 3, 7, 15 ,30 and 60 day. All patients were followed up to definite their biliary complications within postoperative 1 year.Results: There was no significant difference at the time of pre-ischemia of bilary between group A and group B(p>0.05). But at the time of pre-reperfusion of hepatic artery, we can found that the warm ischemia injury of group B was more serious than that of group A. We can found that there were outstanding changes of biliary epithelia structure, such as distention of cells , nucleolus concentrate, vacuolar denaturalization of plasm, microvillus desquamation,separation of base and so on. There was significant difference at the herlt scores between group A and group B(p<0.05).The TBIL of B group are higher than of A group, Also the times of recovery of B group are longer than ofA group , As well as the difference was significant (p<0.05). A group had two patients distubted with biliary complication.,and B group had one.Conclusion if there has a longer time of CIT biliary would have a more fragility for second warm ischemia and a more serious injury could result in it. As a result, reducing the time of CIT and opening portal vein and hepatica artery at equal pace will abate biliary damage. The damage of biliary epithelia is reciprocity, which do not increase the rate of biliary complications.