| 摘要 |
To evaluate the effect of octreotide on the pancrearic graft perfusion and
graft pancreatitis after pancreas transplantation, Lee-Sung strain of miniature
inbred pigs (n=24) were used both as donors and as pancreatectomized recipients for heterotopic pancreaticoduodenal transplantation. Following grat procurement, Belzer-University Wisconcin (UW) solution was used as preservation solution. The cold ischemia time was in average 2 hr 31 min. The portal vein of the graft was anastomosed to the distal inferior vena cava of the recipient, and the Carrel’s aortic patch of the graft including the orifices of the superior mesentery artery and the celiac axis was anastomosed to the right common iliac artery of the recipient. The pancreatic secretion of the gra缸was drained through a segment of duodenum by a duodeno-duodenostomy. For the recipients in the experimental group (n=6), intravenous infusion {from 30 min before reperfusion) of 2 mg/kg/hr of octreotide was also administered for 6 hours, followed by a subcutaneous dose of 20 mg/kg every 8 hours for 5 to 7 days. Octreotide was not administered in the control group (n=6). Graft function and pancreatitis was monitored by serial evaluations of blood sugar, serum amylase, lactate dehydrogenase (LDH), and by hexamethylpropylene amineoxide (HMPAO)-Tc99 M scintigraphy and intrayenous glucose tolerance test (IVGTT) in posttransplant
period. The animals were sacrificed 2 ·weeks after transplantation. All the pancreatic grafts showed a prompt endocrine function manifested by blood glucose <200 mg/dl within the first 24 hours and remained normoglycemic thereafter. In comparison, the glucose levels between the two groups were not significantly different during the two weeks of observation. The average k value of post-transplant IVGTT was -2.52±0.65 in the octreotide-infused group, and -2.22±0.27 in the control group (p >0.10). The serum amylase levels were higher in the control group than those of the octreotide-injected group (3939±1801 vs 1905±495 U/L, p< 0.05). However, serum LDH was significantly lower at day 5 in the control group (1789±1087 vs 3178±60~ U／L， p ＜0.05). The HMPAO-Tc99M scintigraphy revealed that pancreas/liver intensity ratios were lower with octeotide injection (44.9±10.1% vs 62.3±12.5%, p< 0.05). Histology of the grafts of both groups at day 14 showed a variety of inflammatory reactions and focal
necrosis in the grafts. However, there was no evidence of pathological difference observed between the two groups. In conclusion, octreotide inhibits
hyperamylasemia following pancreas transplantation. It also reduces graft perfusion. The normoglycemic effect of the graft remains unchanged using octreotide, yet a poltential risk of increasing ischemic damage to the graft
with octreotide should be guarded. |
