Impairment Of Microcirculation In The Early Reperfusion Period Predicts The Degree Of Graft Pancreatitis In Clinical Pancreas Transplantation
2001
Background Graft pancreatitis is thought to be induced by ischemia/reperfusion. Animal experiments have suggested that an impaired
microcirculationis crucial in this process. We have therefore studied the relevance of
microcirculationin clinical
pancreas transplantation. Methods. In 17 patients undergoing
pancreas transplantation, tissue pO 2 was monitored continuously by an electrode implanted into the
pancreatic tail. A catheter was inserted in the distal part of the
splenic veinof the pancreas graft. After reperfusion blood samples were taken from this catheter and blood flow was measured by the venous outflow method. The degree of graft pancreatitis was assessed by peak-C-reactive protein (CRP) defined as highest CRP within 3 days after transplantation. Results. Tissue pO 2 increased within 5 min after reperfusion. Thereafter, in most patients a transient decrease was noted, indicating impairment of nutritive perfusion. During this period there was an increasing negative correlation between peak-CRP and tissue pO 2 which was highly significant at 60 min after reperfusion (r=-0.70, P<0.002). Also donor age correlated significantly with peak-CRP (r=0.64, P<0.005) and to a somewhat lesser extend with tissue pO 2 60 min after reperfusion (r=-0.55, P<0.03). Conclusion. These data show that the degree of organ damage in clinical
pancreas transplantationis directly related to an impairment of
microcirculationin the early reperfusion period. These data also support the idea that grafts from older donors have a higher probability to develop graft pancreatitis and that this might be due to an increased incidence of microcirculatory disturbances in these organs.
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