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Acosta F, Sansano T, Palenciano CG, Reche M, Roques V, Beltran R, Robles R, Bueno FS, Ramirez P, Parrilla P. Efficiency of the vasoconstrictor response to vascular exclusion in patients with alcoholic cirrhosis undergoing liver transplantation. Transplant Proc 2000; 32:2662-3. [PMID: 11134751 DOI: 10.1016/s0041-1345(00)01831-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Acosta F, Diaz J, Sansano T, Palenciano CG, Reche M, Roques V, Beltran R, Robles R, Bueno FS, Ramirez P, Parrilla P. Hemodynamics related to metabolic changes at reperfusion during liver transplantation. Transplant Proc 2000; 32:2649-50. [PMID: 11134743 DOI: 10.1016/s0041-1345(00)01823-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Acosta F, Rodriguez MA, Sansano T, Palenciano CG, Reche M, Roques V, Beltran R, Robles R, Bueno FS, Ramirez P, Parrilla P. Influence of surgical technique on diuresis during liver transplantation. Transplant Proc 2000; 32:2657. [PMID: 11134747 DOI: 10.1016/s0041-1345(00)01827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ramirez P, Chavez R, Majado M, Munitiz V, Muñoz A, Hernandez Q, Palenciano CG, Pino-Chavez G, Loba M, Minguela A, Yelamos J, Gago MR, Vizcaino AS, Asensi H, Cayuela MG, Segura B, Marin F, Rubio A, Fuente T, Robles R, Bueno FS, Sansano T, Acosta F, Rodriguez JM, Navarro F, Cabezuelo J, Cozzi E, White DJ, Calne RY, Parrilla P. Life-supporting human complement regulator decay accelerating factor transgenic pig liver xenograft maintains the metabolic function and coagulation in the nonhuman primate for up to 8 days. Transplantation 2000; 70:989-98. [PMID: 11045632 DOI: 10.1097/00007890-200010150-00001] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND It is not known whether the pig liver is capable of functioning efficiently when transplanted into a primate, neither is there experience in transplanting a liver from a transgenic pigs expressing the human complement regulator human complement regulator decay accelerating factor (h-DAF) into a baboon. The objective of this study was to determine whether the porcine liver would support the metabolic functions of non-human primates and to establish the effect of hDAF expression in the prevention of hyperacute rejection of porcine livers transplanted into primates. METHODS Five orthotopic liver xenotransplants from pig to baboon were carried out: three from unmodified pigs and two using livers from h-DAF transgenic pigs. FINDINGS The three control animals transplanted with livers from unmodified pigs survived for less than 12 hr. Baboons transplanted with livers from h-DAF transgenic pigs survived for 4 and 8 days. Hyperacute rejection was not detected in the baboons transplanted with hDAF transgenic pig livers; however, it was demonstrated in the three transplants from unmodified pigs. Baboons transplanted with livers from h-DAF transgenic pigs were extubated at postoperative day 1 and were awake and able to eat and drink. In the recipients of hDAF transgenic pig livers the clotting parameters reached nearly normal levels at day 2 after transplantation and remained normal up to the end of the experiments. In these hDAF liver recipients, porcine fibrinogen was first detected in the baboon plasma 2 hr postreperfusion, and was present up to the end of the experiments. One animal was euthanized at day 8 after development of sepsis and coagulopathy, the other animal arrested at day 4, after an episode of vomiting and aspiration. The postmortem examination of the hDAF transgenic liver xenografts did not demonstrate rejection. INTERPRETATION The livers from h-DAF transgenic pigs did not undergo hyperacute rejection after orthotopic xenotransplantation in baboons. When HAR is abrogated, the porcine liver maintains sufficient coagulation and protein levels in the baboon up to 8 days after OLT.
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Ramirez P, Chavez R, Majado M, Munitiz V, Muñoz A, Hernandez Q, Palenciano C, Pino-Chavez G, Loba M, Minguela A, Yelamos J, Vizcaino AS, Asensi H, Cayuela MG, Segura B, Marin F, Rubio A, Rios A, Fuente T, Robles R, Sanchez F, Sansano T, Acosta F, Rodriguez JM, Navarro F, Cabezuelo J. The porcine liver supports metabolic homeostasis in the nonhuman primate: experimental study in a model of orthotopic liver transplantation from h-DAF transgenic pig to baboon. Transplant Proc 2000; 32:1112-3. [PMID: 10936385 DOI: 10.1016/s0041-1345(00)01150-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dalmau A, Sabaté A, Acosta F, Garcia-Huete L, Koo M, Sansano T, Rafecas A, Figueras J, Jaurrieta E, Parrilla P. Tranexamic acid reduces red cell transfusion better than epsilon-aminocaproic acid or placebo in liver transplantation. Anesth Analg 2000; 91:29-34. [PMID: 10866882 DOI: 10.1097/00000539-200007000-00006] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED We evaluated the efficacy of the prophylactic administration of epsilon-aminocaproic acid and tranexamic acid for reducing blood product requirements in orthotopic liver transplantation (OLT) in a prospective, double-blinded study performed in 132 consecutive patients. Patients were randomized to three groups and given one of three drugs prophylactically: tranexamic acid, 10 mg. kg(-1). h(-1); epsilon-aminocaproic acid, 16 mg. kg(-1). h(-1), and placebo (isotonic saline). Perioperative management was standardized. Coagulation tests, thromboelastogram, and blood requirements were recorded during OLT and in the first 24 h. There were no differences in diagnosis, Child score, or preoperative coagulation tests among groups. Administration of packed red blood cells was significantly reduced (P = 0.023) during OLT in the tranexamic acid group, but not in the epsilon-aminocaproic acid group. There were no differences in transfusion requirements after OLT. Thromboembolic events, reoperations, and mortality were similar in the three groups. Prophylactic administration of tranexamic acid, but not epsilon-aminocaproic acid, significantly reduces total packed red blood cell usage during OLT. IMPLICATIONS In a randomized study of 132 consecutive patients undergoing liver transplantation, we found that tranexamic acid, but not epsilon-aminocaproic acid, reduced intraoperative total packed red blood cell transfusion.
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Acosta F, De La Morena G, Villegas M, Sansano T, Reche M, Beltran R, Roques V, Contreras RF, Robles R, Bueno FS, Ramirez P, Parrilla P. Evaluation of cardiac function before and after liver transplantation. Transplant Proc 1999; 31:2369-70. [PMID: 10500622 DOI: 10.1016/s0041-1345(99)00383-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Acosta F, Sansano T, Reche M, Roques V, Beltran R, Rodriguez MA, Contreras RF, Robles R, Bueno FS, Ramirez P, Parrilla P. Is there a cirrhotic myocardiopathy in patients proposed for liver transplantation? Transplant Proc 1999; 31:2368. [PMID: 10500621 DOI: 10.1016/s0041-1345(99)00382-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Acosta F, De La Morena G, Villegas M, Sansano T, Reche M, Beltran R, Roques V, Contreras RF, Robles R, Bueno FS, Ramirez P, Parrilla P. Cardiac evaluation of patients with familial amyloidotic polyneuropathy proposed for liver transplantation. Transplant Proc 1999; 31:2372. [PMID: 10500624 DOI: 10.1016/s0041-1345(99)00385-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Acosta F, Sansano T, Contreras RF, Reche M, Beltran R, Roques V, Rodriguez MA, Robles R, Bueno FS, Ramirez P, Parrilla P. Changes in serum potassium during reperfusion in liver transplantation. Transplant Proc 1999; 31:2382-3. [PMID: 10500630 DOI: 10.1016/s0041-1345(99)00391-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Acosta F, Sansano T, Robles R, Contreras RF, Reche M, Beltran R, Roques V, Rodriguez MA, Bueno FS, Ramirez P, Parrilla P. Hemodynamic consequences of portal and lateral clamping of the inferior vena cava during liver transplantation. Transplant Proc 1999; 31:2413-4. [PMID: 10500647 DOI: 10.1016/s0041-1345(99)00408-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Acosta F, Sansano T, Contreras RF, Reche M, Beltran R, Roques V, Rodriguez MA, Robles R, Bueno FS, Ramirez P, Parrilla P. Hemodynamic profile in cirrhotic patients undergoing liver retransplantation due to chronic rejection. Transplant Proc 1999; 31:2371. [PMID: 10500623 DOI: 10.1016/s0041-1345(99)00384-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Acosta F, Serrano E, Diaz J, Carbonell L, Sansano T, Beltran R, Roques V, Contreras RF, Robles R, Bueno FS, Ramirez P, Parrilla P. Hemodynamic consequences of oxidative stress following reperfusion during liver transplantation. Transplant Proc 1999; 31:2375-6. [PMID: 10500626 DOI: 10.1016/s0041-1345(99)00387-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Acosta F, Sansano T, Contreras RF, Reche M, Roques V, Beltran R, Rodriguez MA, Robles R, Bueno FS, Ramirez P, Parrilla P. Phenylephrine treatment of the postreperfusion syndrome in liver transplantation. Transplant Proc 1999; 31:2373-4. [PMID: 10500625 DOI: 10.1016/s0041-1345(99)00386-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Acosta F, Reche M, Sansano T, Contreras RF, Beltran R, Roques V, Rodriguez MA, Robles R, Bueno FS, Ramirez P, Parrilla P. Effect of reperfusion on right ventriculoarterial coupling in liver transplantation. Transplant Proc 1999; 31:2384-5. [PMID: 10500631 DOI: 10.1016/s0041-1345(99)00392-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Acosta F, Rodriguez MA, Sansano T, Contreras RF, Reche M, Roques V, Beltran R, Robles R, Bueno FS, Ramirez P, Parrilla P. Influence of surgical technique on postreperfusion syndrome during liver transplantation. Transplant Proc 1999; 31:2380-1. [PMID: 10500629 DOI: 10.1016/s0041-1345(99)00390-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Acosta F, Sansano T, Rodriguez MA, Contreras RF, Reche M, Beltran R, Roques V, Robles R, Bueno FS, Ramirez P, Parrilla P. Need for venovenous bypass in patients with familial amyloidotic polyneuropathy treated with liver transplantation. Transplant Proc 1999; 31:2394-5. [PMID: 10500636 DOI: 10.1016/s0041-1345(99)00397-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Acosta F, Rodriguez MA, Sansano T, Contreras RF, Reche M, Roques V, Beltran R, Robles R, Bueno FS, Ramirez P, Parrilla P. Need for inotropic and/or vasopressor drugs during liver transplantation. Transplant Proc 1999; 31:2402-3. [PMID: 10500640 DOI: 10.1016/s0041-1345(99)00401-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Acosta F, Sansano T, Contreras RF, Reche M, Beltran R, Roques V, Rodriguez MA, Robles R, Bueno FS, Ramirez P, Parrilla P. Atropine prophylaxis of the postreperfusion syndrome in liver transplantation. Transplant Proc 1999; 31:2377. [PMID: 10500627 DOI: 10.1016/s0041-1345(99)00388-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Acosta F, Diaz J, Fuente T, Sansano T, Robles R, Ramirez P, Bueno FS, Parrilla P. Plasma beta-endorphin levels during liver transplantation in patients with familial amyloidotic polyneuropathy. Clin Biochem 1996; 29:393-5. [PMID: 8828972 DOI: 10.1016/0009-9120(96)00040-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Diaz J, Acosta F, Parrilla P, Sansano T, Tornel PL, Robles R, Ramirez P, Bueno FS, Martinez P. Serum ionized magnesium monitoring during orthotopic liver transplantation. Transplantation 1996; 61:835-7. [PMID: 8607193 DOI: 10.1097/00007890-199603150-00028] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
During orthotopic liver transplantation (OLT) citrate accumulates and magnesium can be chelated, which can lead to ionized hypomagnesemia and cardiovascular dysfunction. Our aim was to study the serum ionized magnesium (Me2+) evolution and establish its relation to serum total Mg and citrate levels during OLT. We studied 58 adult patients undergoing OLT. The serum Me2+ level dropped significantly at the end of the preanhepatic phase, and remained low until the end of the procedure. Furthermore, the Me2+ levels remained below the range of reference from the beginning of the anhepatic phase onward. There was an inverse correlation between Me2+ and citrate for all patients. Me2+, like ionized calcium (Ca2+), is chelated by citrate and its evolution is a mirror image of that of citrate. In our patients, we did not observe any significant dysrhythmias that could be directly attributed to ionized hypomagnesemia. In conclusion, low preoperative levels, together with the massive transfusion of blood products and the increase in renal losses, cause progressive ionized hypomagnesemia in OLT patients. We propose that it he routinely monitored and treated accordingly, as is already done with Ca2+.
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Acosta F, Díaz J, Sansano T, Parrilla P. [Cardiac arrhythmias and ionic hypomagnesemia during liver transplantation]. Med Clin (Barc) 1996; 106:196-7. [PMID: 8684022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Acosta F, Diaz J, Parrilla P, Sansano T, Robles R, Ramirez P, Bueno F. Hemodynamic response to hepatic vascular exclusion during liver transplant in patients with familial amyloidotic polineuropathy. Neuromuscul Disord 1996. [DOI: 10.1016/0960-8966(96)88911-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Diaz J, Acosta F, Parrilla P, Sansano T, Contreras RF, Marquez M, Tovar I, Bueno FS, Robles R, Martinez P. Intraoperative evolution of active osmotic agents during orthotopic liver transplantation. Transplant Proc 1995; 27:2307-8. [PMID: 7652820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Acosta F, Diaz J, Moreno J, Fuente T, Contreras RF, Sansano T, Bueno FS, Robles R, Ramirez P, Parrilla P. Relationship between beta-endorphin release and surgical stress in orthotopic liver transplantation. Transplant Proc 1995; 27:2303. [PMID: 7652816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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