A Forensic Study of Hepatic Injury after Trauma and Its Value for Clinical Liver Transplantation_West China Medical Journal

Authors：

 WuXuemei , ZhangXudong , LiuMin , YunLibing ,  YiXufu

Staff Room of Forensic Pathology, West China School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

YiXufu, Email: yixufu@tom.com

Keywords：

Trauma; Hepatic injury; Liver transplantation; Forensic pathology

DOI：

10.7507/1002-0179.201600419

Video：

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Objective To investigate pathological changes of liver and risk factors for hepatic injury after trauma, in order to provide the instructions for clinical liver transplantation and accumulate the pathological data. Methods We retrospectively analyzed the clinical data of 142 patients who died after trauma between January 2010 and December 2014. Based on whether the patients had acute liver damage before dying, they were divided into two groups. The observation group had liver damage before dying, while the control group had not. Combined with the details of trauma, clinical data and autopsy results, we statistically analyzed the pathological changes of liver and risk factors for acute liver damage, including age, gender, trauma kind, trauma site, interval between trauma and hospitalization, damage degree, length of hypotension, the use of more than two vasopressors, large amount of blood transfusion, and complication of shock, infection, or underlying diseases. According to injury severity score (ISS) system, the damage degree was divided into mild damage (ISS<16), moderate damage (ISS≥16 and<25), and severe damage (ISS≥25). Results Among the 142 patients, there were 45 in the observation group with varying degrees of liver cell necrosis, among whom there were 8 mild cases, 14 moderate and 23 severe. There were 97 patients in the control group without acute liver damage, and no significant changes were found in their hepatic tissue. Liver damage was not correlated with age, gender, damage kind, damage site, or pre-hospital time (P>0.05), while it was corrected with the degree of damage, time of hypotension (≥0.5 hour), the use of more than two vasopressors, large amount of blood transfusion (2 000 mL/24 hours), and combination of shock, infection, and other disease except for cardiac and pulmonary diseases (P<0.05). Conclusion When using donor livers from patients dying from trauma for transplantation, physicians should be alert to the factors discussed previously which can increase the risk of hepatic injury. Biopsy is useful to assess the suitability of donor livers prior to transplantation.

Citation： WuXuemei, ZhangXudong, LiuMin, YunLibing, YiXufu. A Forensic Study of Hepatic Injury after Trauma and Its Value for Clinical Liver Transplantation. West China Medical Journal, 2016, 31(9): 1538-1542. doi: 10.7507/1002-0179.201600419 Copy

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9.	Tselepidis S, Papazoglou L, Dessiris A, et al. Liver injury after ischemia and reperfusion:the role of oxygen free radicals[J]. Mil Med, 2004, 169(7):531.
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11.	陰英, 藍宇, 孫成棟. 創傷后肝功能變化及其臨床意義[J]. 世界華人消化雜志, 2008, 16(2):217-220.
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13.	Harbrecht BG, Doyle HR, Clancy KD, et al. The impact of liver dysfunction on outcome in patients with multiple injuries[J]. Am Surg, 2001, 67(2):122.
14.	農江, 孫煦勇, 董建輝, 等. 腦死亡供體肝臟病理改變及臨床移植應用評估的探討[J]. 熱帶醫學雜志, 2012, 12(12):1451-1453.
15.	Flechtenmacher C, Schirmacher P, Schemmer P. Donor liver histology--a valuable tool in graft selection[J].Langenbecks Arch Surg, 2015, 400(5):1-7.
16.	Melin C, Miick R, Young NA, et al. Approach to intraoperative consultation for donor liver biopsies[J]. Arch Pathol Lab Med, 2013, 137(2):270-274.
17.	Henrion J. Ischemia/reperfusion injury of the liver:pathophysiologic hypotheses and potential relevance to human hypoxic hepatitis[J].Acta Gastroenterol Belg, 1999, 63(4):336-347.

1. 鄭樹森. 臨床肝移植的熱點問題[J]. 器官移植, 2010, 1(1):7-8.
2. 陳規劃. 中國大陸肝移植:過去, 現在和將來[J]. 器官移植, 2010, 1(1):5-6.
3. Nast-Kolb D, Aufmkolk M, Rucholtz S, et al. Multiple organ failure still a major cause of morbidity but not mortality in blunt multiple trauma[J]. J Trauma, 2001, 51(5):835-841.
4. Shen J, Chong AS, Xiao F, et al. Histological characterization and pharmacological control of chronic rejection in xenogeneic and allogeneic hearttransplantation[J]. Transplantation.1998, 65(5):692-698.
5. 布蘇提, 金特曼, 楊甲梅, 等. 肝移植[M]. 上海:第二軍醫大學出版社, 2009:395.
6. 陳實. 移植學[M]. 北京:人民衛生出版社, 2011:500.
7. 丁義濤, 江春平. 努力拓展供肝來源[J]. 中華器官移植雜志, 2012, 33(4):193-194.
8. Nunes G, Blaisdell FW, Margaretten W. Mechanism of hepatic dysfunction following shock and trauma[J]. Arch Surg, 1970, 100(5):546-556.
9. Tselepidis S, Papazoglou L, Dessiris A, et al. Liver injury after ischemia and reperfusion:the role of oxygen free radicals[J]. Mil Med, 2004, 169(7):531.
10. Zygun DA, Kortbeek JB, Fick GH, et al. Non-neurologic organ dysfunction in severe traumatic brain injury[J]. Critl Care Med, 2005, 33(3):654-660.
11. 陰英, 藍宇, 孫成棟. 創傷后肝功能變化及其臨床意義[J]. 世界華人消化雜志, 2008, 16(2):217-220.
12. 陰英, 藍宇, 孫成棟. 105例創傷后肝功能損害的影響因素分析[J].北京醫學, 2008, 30(3):133-136.
13. Harbrecht BG, Doyle HR, Clancy KD, et al. The impact of liver dysfunction on outcome in patients with multiple injuries[J]. Am Surg, 2001, 67(2):122.
14. 農江, 孫煦勇, 董建輝, 等. 腦死亡供體肝臟病理改變及臨床移植應用評估的探討[J]. 熱帶醫學雜志, 2012, 12(12):1451-1453.
15. Flechtenmacher C, Schirmacher P, Schemmer P. Donor liver histology--a valuable tool in graft selection[J].Langenbecks Arch Surg, 2015, 400(5):1-7.
16. Melin C, Miick R, Young NA, et al. Approach to intraoperative consultation for donor liver biopsies[J]. Arch Pathol Lab Med, 2013, 137(2):270-274.
17. Henrion J. Ischemia/reperfusion injury of the liver:pathophysiologic hypotheses and potential relevance to human hypoxic hepatitis[J].Acta Gastroenterol Belg, 1999, 63(4):336-347.

West China Medical Journal

A Forensic Study of Hepatic Injury after Trauma and Its Value for Clinical Liver Transplantation

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