The aim of this prospective study is to evaluate prostanoid (prostacyclin and thromboxane) and li... more The aim of this prospective study is to evaluate prostanoid (prostacyclin and thromboxane) and lipid peroxide levels at the portal and hepatic veins, and their relation to immediate postoperative liver function. Nineteen patients with liver cirrhosis undergoing orthotopic liver transplantation were prospectively studied. Blood samples were obtained within 5 min and 1 and 2 hr after reperfusion of the new liver, through a catheter placed at the portal vein in the recipient and another at the left hepatic vein in the donor liver. Plasma prostacyclin and thromboxane were analyzed by HPLC and RIA. The formation of lipid peroxides was determined and expressed in terms of thiobarbituric acid-reacting substances. Immediate postoperative liver function was evaluated using the transaminase levels within the first 48 hr and the early postoperative graft function score, as described previously. After reperfusion, only determinations at 5 min were related with liver function. Either prostacyclin (R = -0.61, P = 0.004) levels at the hepatic vein or prostacyclin production (subtraction between hepatic and portal vein levels) (R = -0.47, P = 0.04) correlated significantly with the early postoperative graft function score. Besides, there was a significant relationship between lipid peroxide production as measured by thiobarbituric acid-reacting substances and a worse early postoperative graft function score (R = 0.61, P = .005). These results suggest that prostacyclin released after liver grafting attenuates preservation and reperfusion damage of the liver, supporting the hypothesis that there is an imbalance of prostanoids within the microvasculature in patients with a compromised postoperative liver function. Our results agree with the involvement of some degree of lipid peroxidation products in the damage of hepatocytes during anoxia and reperfusion.
during liver transplantation, and renal impairment per-Although venovenous bypass (VVBP) has been... more during liver transplantation, and renal impairment per-Although venovenous bypass (VVBP) has been sugsists during the early postoperative period. Because gested to protect the kidneys during liver transplanta-VVBP support is not associated with any clear benefit tion and its systematic use has therefore been recomin renal function, its systematic use does not seem to be mended, this beneficial effect of VVBP has not been justified. (HEPATOLOGY 1996;23:1418-1428.) clearly demonstrated. In a prospective, randomized, controlled trial, 77 patients receiving liver transplants In spite of the large clinical experience in human for chronic liver disease were allocated to be supported liver transplantation, the intraoperative management with VVBP (group 1, 38 patients) or not (group 2, 39 of this procedure remains challenging for surgeons and patients). Both groups were similar in relation to preoperative clinical and laboratory data and operative transanesthesiologists, particularly during the anhepatic fusion requirements. Inulin clearance and urinary b 2phase of transplantation, when marked hemodynamic microglobulin and N-acetyl-b-D-glucosaminidase (NAG) changes occur as a consequence of the interruption of excretion (to determine glomerular filtration rate and venous flow through the portal vein and inferior vena tubular damage, respectively) were measured at differcava. 1-8 To reduce the intensity of these hemodynamic ent perioperative periods (anesthesia induction, hepaderangements, venovenous bypass (VVBP) from infetectomy, anhepatic phase, biliary anastomosis, and 24 rior caval vein and portal vein territories to superior hours after surgery). A significant decrease in inulin caval vein territory was introduced in 1984. 9,10 In addiclearance and increase in tubular damage markers were tion to its beneficial hemodynamic effect during the observed in the anhepatic phase, which only partly imanhepatic phase of liver transplantation, VVBP has proved in the subsequent phases. No significant differences were observed between groups 1 and 2 at any peribeen suggested by several authors to protect the kidoperative phase, except during the anhepatic phase, in neys from the damage secondary to the interruption which a more marked renal function impairment ocof renal venous outflow. 3,10 Because of these potential curred in group 2 patients. However, renal function on benefits of VVBP, a number of transplant centers are the 7th postoperative day and the need for hemodialysis/ routinely performing VVBP during orthotopic liver hemofiltration during the 1st week were similar in both transplantation. 6,11 However, the systematic use of groups. Among 40 variables analyzed, only low mean ar-VVBP has been questioned by other authors who have terial pressure at anesthesia induction was identified as failed to prove the theoretical advantage of VVBP in an independent predictor for early postoperative severe relation to its supposed protective effect on renal funcrenal failure (inulin clearance õ 10 mL/min/1.73 m 2 at tion. 3,6 Furthermore, it is important to remark that all the 24th postoperative hour), with no significant relationship between this complication and the use of venothe studies performed to assess the efficacy of VVBP venous bypass. Renal function markedly deteriorates in protecting the kidneys during liver transplantation have consisted of noncontrolled investigations. Therefore, we performed the present randomized, controlled Abbreviations: VVBP, venovenous bypass; NAG, N-acetyl-b-D-glucosamini-trial aimed at prospectively investigating the effects dase; BUN, blood urea nitrogen.
Intrahepatic biliary lesions (IBL) are rare (2-9 %) after orthotopic liver transplantation (OLT).... more Intrahepatic biliary lesions (IBL) are rare (2-9 %) after orthotopic liver transplantation (OLT). The aim was to evaluate the incidence, etiology and outcome. In nine years, a total 532 OLTs were performed in 481 patients. Twentyfour patients developed IBL. Eight were due to HAT, seven to ABOI, three to CDR and six to PI. The time until diagnosis of HAT is longest in patients (14 ? 6) with IBL. ABOI is another cause of IBL. CDR is a rare cause of IBL, however when it takes place, patients must undergo Rtx. Finally, PI is a relevant cause of IBL. In order to suppress the incidence of IBL we should consider 1) the systematic use of Dop-pler-Ultrasound; 2) emergency reoperation of patients with HAT, 3) avoid ABOI in OLT; 4) Rtx in cases of CDR, and 5) OLT should still be performed as an emergency procedure. Keywords Liver. Lesions. Biliary Abbreviations ABOI ABO-incompatible blood group donors. CDR Chronic ductopenic rejection DUS Duplex ultrasound exploration. ER Emergency revascularization. HAT Hepatic artery thrombosis. ZBL Intrahepatic biliary lesions. OLT Orthotopic liver transplantation. PI Preservation injury. Rrx Retransplantation
The aim of this prospective study is to evaluate prostanoid (prostacyclin and thromboxane) and li... more The aim of this prospective study is to evaluate prostanoid (prostacyclin and thromboxane) and lipid peroxide levels at the portal and hepatic veins, and their relation to immediate postoperative liver function. Nineteen patients with liver cirrhosis undergoing orthotopic liver transplantation were prospectively studied. Blood samples were obtained within 5 min and 1 and 2 hr after reperfusion of the new liver, through a catheter placed at the portal vein in the recipient and another at the left hepatic vein in the donor liver. Plasma prostacyclin and thromboxane were analyzed by HPLC and RIA. The formation of lipid peroxides was determined and expressed in terms of thiobarbituric acid-reacting substances. Immediate postoperative liver function was evaluated using the transaminase levels within the first 48 hr and the early postoperative graft function score, as described previously. After reperfusion, only determinations at 5 min were related with liver function. Either prostacyclin (R = -0.61, P = 0.004) levels at the hepatic vein or prostacyclin production (subtraction between hepatic and portal vein levels) (R = -0.47, P = 0.04) correlated significantly with the early postoperative graft function score. Besides, there was a significant relationship between lipid peroxide production as measured by thiobarbituric acid-reacting substances and a worse early postoperative graft function score (R = 0.61, P = .005). These results suggest that prostacyclin released after liver grafting attenuates preservation and reperfusion damage of the liver, supporting the hypothesis that there is an imbalance of prostanoids within the microvasculature in patients with a compromised postoperative liver function. Our results agree with the involvement of some degree of lipid peroxidation products in the damage of hepatocytes during anoxia and reperfusion.
during liver transplantation, and renal impairment per-Although venovenous bypass (VVBP) has been... more during liver transplantation, and renal impairment per-Although venovenous bypass (VVBP) has been sugsists during the early postoperative period. Because gested to protect the kidneys during liver transplanta-VVBP support is not associated with any clear benefit tion and its systematic use has therefore been recomin renal function, its systematic use does not seem to be mended, this beneficial effect of VVBP has not been justified. (HEPATOLOGY 1996;23:1418-1428.) clearly demonstrated. In a prospective, randomized, controlled trial, 77 patients receiving liver transplants In spite of the large clinical experience in human for chronic liver disease were allocated to be supported liver transplantation, the intraoperative management with VVBP (group 1, 38 patients) or not (group 2, 39 of this procedure remains challenging for surgeons and patients). Both groups were similar in relation to preoperative clinical and laboratory data and operative transanesthesiologists, particularly during the anhepatic fusion requirements. Inulin clearance and urinary b 2phase of transplantation, when marked hemodynamic microglobulin and N-acetyl-b-D-glucosaminidase (NAG) changes occur as a consequence of the interruption of excretion (to determine glomerular filtration rate and venous flow through the portal vein and inferior vena tubular damage, respectively) were measured at differcava. 1-8 To reduce the intensity of these hemodynamic ent perioperative periods (anesthesia induction, hepaderangements, venovenous bypass (VVBP) from infetectomy, anhepatic phase, biliary anastomosis, and 24 rior caval vein and portal vein territories to superior hours after surgery). A significant decrease in inulin caval vein territory was introduced in 1984. 9,10 In addiclearance and increase in tubular damage markers were tion to its beneficial hemodynamic effect during the observed in the anhepatic phase, which only partly imanhepatic phase of liver transplantation, VVBP has proved in the subsequent phases. No significant differences were observed between groups 1 and 2 at any peribeen suggested by several authors to protect the kidoperative phase, except during the anhepatic phase, in neys from the damage secondary to the interruption which a more marked renal function impairment ocof renal venous outflow. 3,10 Because of these potential curred in group 2 patients. However, renal function on benefits of VVBP, a number of transplant centers are the 7th postoperative day and the need for hemodialysis/ routinely performing VVBP during orthotopic liver hemofiltration during the 1st week were similar in both transplantation. 6,11 However, the systematic use of groups. Among 40 variables analyzed, only low mean ar-VVBP has been questioned by other authors who have terial pressure at anesthesia induction was identified as failed to prove the theoretical advantage of VVBP in an independent predictor for early postoperative severe relation to its supposed protective effect on renal funcrenal failure (inulin clearance õ 10 mL/min/1.73 m 2 at tion. 3,6 Furthermore, it is important to remark that all the 24th postoperative hour), with no significant relationship between this complication and the use of venothe studies performed to assess the efficacy of VVBP venous bypass. Renal function markedly deteriorates in protecting the kidneys during liver transplantation have consisted of noncontrolled investigations. Therefore, we performed the present randomized, controlled Abbreviations: VVBP, venovenous bypass; NAG, N-acetyl-b-D-glucosamini-trial aimed at prospectively investigating the effects dase; BUN, blood urea nitrogen.
Intrahepatic biliary lesions (IBL) are rare (2-9 %) after orthotopic liver transplantation (OLT).... more Intrahepatic biliary lesions (IBL) are rare (2-9 %) after orthotopic liver transplantation (OLT). The aim was to evaluate the incidence, etiology and outcome. In nine years, a total 532 OLTs were performed in 481 patients. Twentyfour patients developed IBL. Eight were due to HAT, seven to ABOI, three to CDR and six to PI. The time until diagnosis of HAT is longest in patients (14 ? 6) with IBL. ABOI is another cause of IBL. CDR is a rare cause of IBL, however when it takes place, patients must undergo Rtx. Finally, PI is a relevant cause of IBL. In order to suppress the incidence of IBL we should consider 1) the systematic use of Dop-pler-Ultrasound; 2) emergency reoperation of patients with HAT, 3) avoid ABOI in OLT; 4) Rtx in cases of CDR, and 5) OLT should still be performed as an emergency procedure. Keywords Liver. Lesions. Biliary Abbreviations ABOI ABO-incompatible blood group donors. CDR Chronic ductopenic rejection DUS Duplex ultrasound exploration. ER Emergency revascularization. HAT Hepatic artery thrombosis. ZBL Intrahepatic biliary lesions. OLT Orthotopic liver transplantation. PI Preservation injury. Rrx Retransplantation
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