Karaciğer transplantasyonunda tiyopental’in soğuk iskemi üzerine etkileri: Deneysel bir çalışma

Öz

Amaç: Bu çalışmanın amacı; tiyopentalin metabolizma hızını azaltıcı etkisinden faydalanarak, organ nakli öncesi uygulanacak olan dozlar ile, nakledilecek organın bazal metabolizma hızını düşürerek enerji ihtiyacını azaltmak ve bu sayede soğuk iskemi sürecinde meydana gelebilecek doku hasarını en aza indirerek organların viabilitesini artırmaktır.

Yöntemler: Çalışmada kullanılan 20 adet Wistar Albino cinsi sıçan iki gruba ayrılmıştır. Grup 1 (Kontrol=Ketamin-Ksilazin grubu) ve Grup 2 (Tiyopental grubu)’deki sıçanlara, kendi grupları için uygun olan ajanlarla anestezi uygulandıktan sonra karın derisi traşlanıp orta hat insizyonu yapıldı. Portal vene bir kanül ile girilerek +4 °C’deki organ saklama sıvısı enjekte edildi. Böylece karaciğer perfüzyonu sağlandı. Ardından hepatektomi yapılarak karaciğerler, içerisinde +4°C’de organ saklama sıvısı bulunan Falkon tüplere konuldu ve yine +4°C’de saklandı. 12 saat saklama süresinin sonunda histopatolojik ve TUNEL değerlendirmeler için doku örnekleri alınırken, saklama sıvısından da biyokimyasal analizler için numune alındı.

Bulgular: Histopatolojik değerlendirme sonucunda, hidropik dejenerasyon ve sinusoidal dilatasyon ortalamaları grup 1’de Grup 2’ye kıyasla yüksek bulundu ancak sonuçlar istatistiksel olarak anlamlı değildi. Apoptotik indeks (AI) değerleri Grup 1’de Grup 2’ye kıyasla yüksekti ancak ortanca değerlerinde istatistiksel olarak anlamlı bir farklılık bulunmadı(sırasıyla 3.50 (Min:1.00-Max:16.00) vs. 2.50 (Min:1.00-Max:20.00) p=0.974). Biyokimyasal ALT, AST ve ALP ortalama değerleri de Grup 1’de yüksek bulundu.

Sonuç: Sonuç olarak, tiyopentalin, soğuk iskemi sürecinde karaciğer dokusu üzerine koruyucu bir etkisi olduğu ve bu etkiyi histopatolojik, apopitotik ve biyokimyasal değerlendirme sonuçlarının ortalama değerlerini azaltmak yoluyla gerçekleştirdiği görülmüştür, ancak bu bulgular istatistiksel olarak anlamlı bulunamamıştır.

Anahtar Kelimeler

• Tiyopental,Soğuk iskemi,Karaciğer nakli,TUNEL,Histopatoloji

Effects of thiopental in cold ischemia in liver transplantation: An experimental study

Abstract

Aim: The aim of this study is to use the reducing effect of thiopental on metabolic rate to reduce basal metabolic rate and thus energy requirements in organs with doses administered before organ transplantation and in this way to increase organ viability by reducing to a minimum tissue damage occurring during the cold ischemia process.

Methods: The study was started with 20 Wistar albino rats in 2 groups. In Group 1 (Control=Ketamine-Xylazine group) and Group 2 (Thiopental group), rats had a midline incision made after shaving the abdominal region under anesthesia with appropriate agents. The portal vein was entered with a cannula and organ storage solution at +4 °C was injected to the portal vein to perfuse the liver. Then hepatectomy was performed, the livers were placed in Falcon tubes containing +4°C organ storage solution and stored at +4°C. Tissue samples were taken for histopathologic and TUNEL investigation and storage solution samples were taken for biochemical analysis at 12th hour.

Results: In histopathologic evaluation, the mean for hydropic degeneration and sinusoidal dilatation was higher in Group 1 compared to Group 2, but the results weren’t statistically significant. Apoptotic Index (AI) values in Group 1 were higher than Group 2; however, there was no statistically significant difference between the median values (3.50 (Min:1.00-Max:16.00) vs. 2.50 (Min:1.00-Max:20.00), respectively p=0.974). The mean values for ALT, AST and ALP were appeared to be higher in Group 1.

Conclusion: In conclusion, thiopental has a protective effect on liver tissue during the cold ischemia process via reducing the mean values of histopathological, apoptotic and biochemical assessment results, but these findings weren’t statistically significant.

Keywords

• Thiopental,Cold ischemia,Liver transplantation,TUNEL,Histopathology

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