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Die UW-Lösung in der Organkonservierung für die orthotope Lebertransplantation

Experimentelle und klinische Ergebnisse

Organ preservation with UW solution for orthotopic liver transplantation

Experimental and clinical results

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Zusammenfassung

Es wird über die Erfahrung mit der University-of-Wisconsin-(UW-)Lösung zur Leberpräservation für die orthotope Lebertransplantation (OLT) berichtet. Es wurde der Einfluß der Dauer der kalten Ischämiezeit (KIZ) in einer klinischen Analyse von 173 Fällen auf die primäre Nichtfunktion (PRNF) des Transplantates und auf Gallengangskomplikationen sowie in einem experimentellen Modell bei Schweinen auf die Morphologie und den Wassergehalt des Lebergewebes, den Gehalt an energiereichen Phosphaten und die Enzymausschwemmung nach Reperfusion untersucht. Bei einer KIZ von mehr als 10 Stunden sind in der klinischen Anwendung der UW-Lösung die PRNF-Rate und die Inzidenz von nicht anastomosenbedingten Gallengangskomplikationen deutlich erhöht. Im experimentellen Modell wurde nach 24 Studen KIZ bei ausreichender Präservation der Hepatozyten die Erhaltung der Mikrozirkulation als limitierender Faktor gefunden. Bei Verwendung von UW-Lösung fand sich, sowohl bei der humanen OLT als auch im Experiment ein signifikanter Zusammenhang zwischen der Dauer der KIZ und der postoperativen Organfunktion.

Summary

The experience in liver preservation for orthotopic liver transplantation (OLT) with University of Wisconsin solution (UW) is reported. In 173 OLT preserved with UW solution, the influence of cold ischemic time (CIT) on primary non function (PRNF) of the graft and bile duct complications was analysed. Furthermore, the impact of CIT on liver histology, liver tissue water and content of high energy phosphates, as well as enzyme release after reperfusion was investigated in an experimental model in pigs. After a CIT of more than 10 hours, the incidence of PRNF and non anastomotic bile duct complications was found increased. In the experimental setting, hepatocytes were considerably well preserved after a CIT of 24 hours, but maintenance of micro-circulation was found to be the limit of graft function. Using UW solution, there was a significant correlation between duration of CIT and postoperative graft function in human and experimental OLT.

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Authors and Affiliations

  1. Chirurgischen Universitätsklinik, Alser Straße 4, A-1090, Wien

    R. Steininger, F. Mühlbacher, E. Roth, T. Grünberger, P. Götzinger, P. Wamser & F. Längle

  2. Institut für Medizinische Physiologie, Wien

    M. Sperlich

  3. Pathologisch-bakteriellen Institut der Allgemeinen Poliklinik, Wien

    H. Reckendorfer

Authors
  1. R. Steininger
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  2. F. Mühlbacher
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  3. E. Roth
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  4. T. Grünberger
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  5. P. Götzinger
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  6. P. Wamser
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  7. F. Längle
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  8. H. Reckendorfer
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  9. M. Sperlich
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Additional information

Prof. Dr.A. FritschZum 65. Geburtstag gewidmet.

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Steininger, R., Mühlbacher, F., Roth, E. et al. Die UW-Lösung in der Organkonservierung für die orthotope Lebertransplantation. Acta Chir Austriaca 24, 231–236 (1992). https://doi.org/10.1007/BF02601753

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  • DOI: https://doi.org/10.1007/BF02601753

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