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Morais LK, Silva Júnior PMD, Moreno JCD, Brasil AMS, Camarço JPF, Martins SB, Quireze Júnior C. Non heart beating organ donor: new experimental model in pigs. Acta Cir Bras 2012; 27:306-10. [PMID: 22666743 DOI: 10.1590/s0102-86502012000500005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 03/19/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To describe technical aspects of a new experimental model that simulates a non heart beating organ donor. METHODS Landrace pigs were operated on and cardiac arrest was obtained by means of myocardial infarction and interruption of ventilator support. RESULTS Mean cardiac frequency, systolic and diastolic blood pressure levels, central venous pressure, oxygen saturation and concentration of expired CO(2) dropout occurred at seven minutes after cardiac arrest. CONCLUSION The procedure was easily reproduced and a homogeneous circulatory failure could de obtained by the end of seven minutes. The model is suitable for further studies regarding abdominal organ transplantation.
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Lechiche C, Le Moing V, François Perrigault P, Reynes J. Fulminant varicella hepatitis in a human immunodeficiency virus infected patient: Case report and review of the literature. ACTA ACUST UNITED AC 2009; 38:929-31. [PMID: 17008242 DOI: 10.1080/00365540600561785] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report the case of a 35-y-old HIV-infected female, who presented fulminant varicella hepatitis and recovered under medical treatment. Varicella zoster virus is an uncommon cause of acute liver disease which occurs mainly in immunocompromised patients. Acyclovir is the cornerstone of the treatment.
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Affiliation(s)
- Catherine Lechiche
- Infectious and Tropical Diseases Unit, Centre Hospitalier Gui de Chauliac, Montpellier, France
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Pishvaian AC, Bahrain M, Lewis JH. Fatal varicella-zoster hepatitis presenting with severe abdominal pain: a case report and review of the literature. Dig Dis Sci 2006; 51:1221-5. [PMID: 16944014 DOI: 10.1007/s10620-006-8037-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Accepted: 11/29/2004] [Indexed: 12/26/2022]
Affiliation(s)
- Aline Charabaty Pishvaian
- Department of Medicine, Division of Gastroenterology, Georgetown University Hospital, 10502 Prairie Landing Terrace, 3800 Reservoir Road NW, Main Building, Washington, DC 20007, USA.
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Net M, Valero R, Almenara R, Barros P, Capdevila L, López-Boado MA, Ruiz A, Sánchez-Crivaro F, Miquel R, Deulofeu R, Taurá P, Manyalich M, García-Valdecasas JC. The effect of normothermic recirculation is mediated by ischemic preconditioning in NHBD liver transplantation. Am J Transplant 2005; 5:2385-92. [PMID: 16162186 DOI: 10.1111/j.1600-6143.2005.01052.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We have evaluated the involvement of hepatic preconditioning mediators (adenosine, adenosine A1 and A2 receptors) during normothermic recirculation (NR) in a model of liver transplantation from non-heart-beating donor (NHBD) pigs. Application of NR after 20 min of warm ischemia (WI) reversed the lethal injury associated with transplantation of NHBD livers (achieving 5-day survival and diminishing glutathione S-transferase (GST), aspartate aminotransferase (AST) and hyaluronic acid (HA)). Adenosine administration prior to WI simulated the effect of NR. Measuring adenosine, we found that during NR, hepatic adenosine levels increased and xanthine levels decreased. Then when we blocked A2 receptors the effect of NR was abolished, whereas the blocking of A1 receptors further protected the liver. Furthermore, A2 blocking improved hepatic perfusion during NR whereas A1 blocking reduced it. The study suggests that NR has a preconditioning effect by maintaining adequate adenosine and xanthine levels. During NR, adenosine protects the liver through A2 activation and damages it through A1 activation although simultaneous stimulation of both receptors exerts a clear beneficial effect. The possible relation of NR mechanism with other preconditioning mediators such as cAMP and nitric oxide synthesis are discussed.
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Affiliation(s)
- Marc Net
- Transplant Coordination, Hospital Clinic de Barcelona, Universitat de Barcelona, Villarroel 170. 08036, Barcelona, Spain
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Nagayama M, Katsuramaki T, Kimura H, Isobe M, Meguro M, Matsuno T, Nui A, Hirata K. Prediction of graft viability from non-heart-beating donor pigs using hepatic microdialysate hypoxanthine levels. J Surg Res 2002; 107:210-8. [PMID: 12429177 DOI: 10.1006/jsre.2002.6514] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-heart-beating donors (NHBDs) are not yet acceptable in orthotopic liver transplantation (OLTX) because of the high frequency of primary graft nonfunction. In this study, we aimed to develop a new predictive method of graft viability in OLTX from NHBDs. MATERIALS AND METHODS (1) Pigs were subjected to 15 min of hepatic ischemia and reperfusion (I/R). (2) Porcine OLTX was performed using grafts obtained from NHBDs subjected to in situ warm ischemia (0, 30, and 60 min). During both operations, hepatic hypoxanthine levels were measured by a microdialysis method. RESULTS In the I/R model, hypoxanthine accumulated during ischemia and decreased after reperfusion, whereas marked xanthine and uric acid production were observed after reperfusion. In the NHBDs model, all of the 0-min group, 6 of 13 pigs in the 30-min group, and 1 of 6 pigs in the 60-min group survived more than 7 days. Significant increases of hypoxanthine levels were seen dependent on warm ischemic time. In the 30-min group, hypoxanthine levels were significantly higher in the pigs that died than in those that survived, and correlated with aspartate aminotransferase, lactate dehydrogenase, and adenosine triphosphate levels of recipients. Histological examination revealed that graft injury was severe in the pigs with higher hypoxanthine levels. CONCLUSIONS It is suggested that hepatic microdialysate hypoxanthine levels during warm ischemia in NHBDs were correlated with graft viability in the recipient. By using of this technique, prediction of the graft viability may be possible during donor operation.
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Affiliation(s)
- Minoru Nagayama
- First Department of Surgery, Sapporo Medical University School of Medicine, Japan.
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Sunose Y, Takeyoshi I, Ohwada S, Tsutsumi H, Iwazaki S, Kawata K, Kawashima Y, Kasahara M, Matsumoto K, Morishita Y. Selective cyclooxygenase-2 inhibitor ameliorates warm ischemia-reperfusion injury of the canine liver. Transplant Proc 2001; 33:862. [PMID: 11267104 DOI: 10.1016/s0041-1345(00)02351-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Y Sunose
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan
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Ikegami T, Nishizaki T, Hiroshige S, Ohta R, Yanaga K, Sugimachi K. Experimental study of a type 3 phosphodiesterase inhibitor on liver graft function. Br J Surg 2001; 88:59-64. [PMID: 11136311 DOI: 10.1046/j.1365-2168.2001.01621.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The number of liver transplant recipients is increasing but donor organ shortages have become more severe. The effect of milrinone, a type 3 phosphodiesterase inhibitor (PDEI), on non-heart-beating donor grafts was evaluated using an orthotopic liver transplantation model in rats. METHODS Type 3 PDEI or normal saline (control group) was given intravenously to the donor animals for 60 min continuously (50 microg kg-1 min-1 ) before 60 min of warm ischaemia followed by cold preservation and subsequent transplantation. Survival, serum chemistry, bile output, histopathological findings and tissue cyclic 3',5'-adenosine monophosphate (cAMP) concentrations were then compared. RESULTS Five of seven animals in the PDEI group were alive at 7 days, compared with only one of seven rats in the control group (P < 0.01). Serum levels of alanine aminotransferase 2 and 6 h after reperfusion, and hyaluronic acid levels 6 h after reperfusion, were significantly lower in the PDEI group than in the control group. Bile output from the transplanted graft was significantly greater in the PDEI group than in controls 2 h after reperfusion (P < 0.01). The mean necrotic area 6 h after reperfusion was also reduced in the PDEI-treated grafts (P < 0.01). cAMP levels in liver tissue at the end of both warm and cold ischaemia, and 2 and 6 h after reperfusion, were significantly higher in the PDEI group compared with those in the control group. CONCLUSION Type 3 PDEI attenuated the graft injury caused by warm and cold ischaemia and subsequent reperfusion injury via an increase in intracellular cAMP levels. This treatment may be a novel pharmacological intervention for safe and efficient usage of liver grafts from non-heart-beating donors.
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Affiliation(s)
- T Ikegami
- Department of Surgery II, Kyushu University, Fukuoka 812-8582, Japan. tikegami#surg2.med.kyushu-u.ac.jp
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Valero R, García-Valdecasas JC, Net M, Beltran J, Ordi J, González FX, López-Boado MA, Almenara R, Taurá P, Elena M, Capdevila L, Manyalich M, Visa J. L-arginine reduces liver and biliary tract damage after liver transplantation from non-heart-beating donor pigs. Transplantation 2000; 70:730-7. [PMID: 11003349 DOI: 10.1097/00007890-200009150-00004] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To evaluate whether L-arginine reduces liver and biliary tract damage after transplantation from non heart-beating donor pigs. METHODS Twenty-five animals received an allograft from non-heart-beating donors. After 40 min of cardiac arrest, normothermic recirculation was run for 30 min. The animals were randomly treated with L-arginine (400 mg x kg(-1) during normothermic recirculation) or saline (control group). Then, the animals were cooled and their livers were transplanted after 6 hr of cold ischemia. The animals were killed on the 5th day, liver damage was assessed on wedged liver biopsies by a semiquantitative analysis and by morphometric analysis of the necrotic areas, and biliary tract damage by histological examination of the explanted liver. RESULTS Seventeen animals survived the study period. The histological parameters assessed (sinusoidal congestion and dilatation, sinusoidal infiltration by polymorphonuclear cells and lymphocytes, endothelitis, dissociation of liver cell plates, and centrilobular necrosis) were significantly worse in the control group. The necrotic area affected 15.9 +/- 14.5% of the liver biopsies in the control group and 3.7 +/- 3.1% in the L-arginine group (P<0.05). Six of eight animal in the control group and only one of eight survivors in the L-arginine group developed ischemic cholangitis (P<0.01). L-Arginine administration was associated with higher portal blood flow (676.9 +/- 149.46 vs. 475.2 +/- 205.6 ml x min x m(-2); P<0.05), higher hepatic hialuronic acid extraction at normothermic recirculation (38.8 +/- 53.7% vs. -4.2 +/- 18.2%; P<0.05) and after reperfusion (28.6 +/- 55.5% vs. -10.9 +/- 15.5%; P<0.05) and lower levels of alpha-glutation-S-transferase at reperfusion (1325 +/- 1098% respect to baseline vs. 6488 +/- 5612%; P<0.02). CONCLUSIONS L-Arginine administration during liver procurement from non heart beating donors prevents liver and biliary tract damage.
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Affiliation(s)
- R Valero
- Department of Anesthesiology, Hospital Clínic of Barcelona, Spain
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Luque P, Alvarez-Vijande R, Alcaraz A, Aguilar A, Alcoberro J, Rodriguez A, Gibanel R, Calatrava P, Helena M, Llopis J, Crisol I, Solé M, Farré X, Talbot-Wright R, Carretero P. Experimental study of the cellular energy charge in pig kidney transplants from non-heart-beating donors. Transplant Proc 1999; 31:2352-3. [PMID: 10500614 DOI: 10.1016/s0041-1345(99)00375-9] [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: 11/28/2022]
Affiliation(s)
- P Luque
- Department of Urology and Renal Transplant, Hospital Clínic of Barcelona, Spain
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Valero R, García-Valdecasas JC, Tabet J, Taurá P, Rull R, Beltran J, García F, González FX, López-Boado MA, Cabrer C, Visa J. Hepatic blood flow and oxygen extraction ratio during normothermic recirculation and total body cooling as viability predictors in non-heart-beating donor pigs. Transplantation 1998; 66:170-6. [PMID: 9701259 DOI: 10.1097/00007890-199807270-00005] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Our aim was to evaluate the hepatic blood flows and oxygen metabolism of non-heart-beating donor (NHBD) pigs, with the use of cardiopulmonary bypass (CPB) and normothermic recirculation (NR) before total body cooling, and its relationship with recipient survival. METHODS Thirty-five pigs were transplanted with an allograft from NHBDs. After warm ischemia (WI) time (20, 30, or 40 min), CPB and NR were run for 30 min. After this period, the animals were cooled to 15 degrees C. In the control group (20 min of WI), the period of NR was excluded. Liver procurement was then performed. RESULTS Survival rate was 100% in the 20WI, 70% in the 30WI, and 50% in the 40WI. Control group survival rate was 0%. Hepatic artery blood flow and portal blood flow recovered during NR. Pump blood flow during CPB increased rapidly during NR and was significantly higher in the 20WI. When donors of the livers transplanted in "surviving pigs" (DSP) were compared with donors of the livers transplanted in "nonsurviving pigs" (DNSP), hepatic artery blood flow, portal blood flow, and pump blood flow were higher in the DSP. Hepatic oxygen extraction ratio increased in the three groups with respect to baseline values. Hepatic oxygen extraction ratio was lower in the 20WI than in the other groups and was lower in the DSP than in the DNSP. CONCLUSIONS The use of a NR period before total body cooling improves survival of liver transplantation in NHBDs. Portal blood flow and pump blood flow measurements can predict the viability of the grafts.
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Affiliation(s)
- R Valero
- Department of Anesthesiology, Hospital Clinic of Barcelona, Spain
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Prolonged hepatic warm ischemia in non-heart-beating donors: protective effects of FK506 and a platelet activating factor antagonist in porcine liver transplantation. Surgery 1998. [PMID: 9626320 DOI: 10.1016/s0039-6060(98)70207-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prolonged warm ischemic injury in non-heart-beating donors (NHBDs) significantly affects hepatic allograft function after liver transplantation (LTx). METHODS The effects of FK506 and the platelet activating factor antagonist E5880 on postoperative function of hepatic allografts procured from NHBDs were evaluated in porcine orthotopic LTx. In donors, livers were subjected to 90 minutes of warm ischemia and a subsequent 4-hour cold preservation. Group 1 (n = 6) was the untreated control group. In group 2 (n = 4), donors were pretreated with FK506 (0.3 mg/kg). In group 3 (n = 4), donors and recipients were treated with E5880 (0.3 mg/kg). In group 4 (n = 6), pigs were treated with both FK506 and E5880. RESULTS All of the recipients in group 1 died within 12 hours. In groups 2 and 3, half of the recipients survived more than 12 hours. In group 4, all of the recipients survived more than 2 days (p < 0.01 compared with group 1). The improved survival seen in group 4 was associated with a reduction in the serum concentrations of glutamic oxaloacetic transaminase and lactate, and a restoration of hepatic energy charge. CONCLUSIONS The present study suggests that FK506 and E5880 can improve the function of hepatic allografts subjected to prolonged warm ischemia in NHBDs, and that the protective effects of the two drugs seem to be synergistic.
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González-Segura C, Castelao AM, Torras J, Moreso F, Riera L, López-Costea MA, Pascual M, Grinyó JM, Alsina J. A good alternative to reduce the kidney shortage: kidneys from nonheartbeating donors. Transplantation 1998; 65:1465-70. [PMID: 9645804 DOI: 10.1097/00007890-199806150-00010] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because of the shortage of kidneys available for transplantation, we began in 1985 to harvest kidneys from non-heartbeating (NHB) donors. METHODS We compared the results of a group of 66 kidney recipients from NHB donors (NHB group) with 122 kidney recipients from heartbeating donors (HB group). We analyzed, in the NHB group, the influence of ischemia times in graft survival and we tested the best cut-offs by receiver operating characteristic curves. We also studied, using a univariate and multivariate Cox hazard model, the capacity of different variables to predict graft loss. RESULTS Patient and graft survival were similar in both groups during the follow-up. The percentage of delayed graft function was the only significant difference between both groups (NHB group 62% vs. HB group 32%; P=0.0001). Delayed graft function, in the NHB group, is influenced by the warm ischemia time, which is directly related to the number of days to achieve a serum creatinine<300 mmol/L (P=0.0001). The best cut-off times in this group were 45 min for warm ischemia time and 22 hr for cold ischemia time. Recipients have a greater likelihood of losing the graft beyond those limits (P=0.017, relative risk: 7.3). The incidence of acute rejection was similar in both groups, and it was the only predictor factor of graft loss in the complete series of patients (P=0.0001), in the NHB group (P=0.007), and in the HB group (P=0.02). CONCLUSIONS Reducing the incidence of acute rejection and shortening ischemia time are conditions needed to guarantee a long graft survival of kidneys from NHB donors.
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Affiliation(s)
- C González-Segura
- Department of Transplant Coordination, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Tabet J, García-Valdecasas JC, Net M, Cifuentes A, González FX, Valero R, Deulofeu R, Rimola A, García F, Visa J. Evaluation of ischemic liver injury during graft procurement from non-heart-beating donor pigs. Transplant Proc 1997; 29:3482-3. [PMID: 9414802 DOI: 10.1016/s0041-1345(97)00988-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- J Tabet
- Department of Surgery, Hospital Clinic of Barcelona, Spain
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Takada Y, Taniguchi H, Fukunaga K, Yuzawa K, Otsuka M, Todoroki T, Iijima T, Fukao K. Hepatic allograft procurement from non-heart-beating donors: limits of warm ischemia in porcine liver transplantation. Transplantation 1997; 63:369-73. [PMID: 9039925 DOI: 10.1097/00007890-199702150-00007] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To investigate the tolerance to warm ischemia of liver grafts from non-heart-beating donors, porcine orthotopic liver transplantation was performed using grafts obtained at various periods after cardiac arrest. Graft viability was investigated in relation to changes in hepatic adenine nucleotide metabolism. In donors, livers were divided into four groups according to warm ischemic time after cardiac arrest (group 1: 0 min, n=3; group 2: 30 min, n=3; group 3: 60 min, n=5; group 4: 90 min, n=4). Thereafter, the livers were flushed and preserved for 4 hr using 4 degrees C Euro-Collins solution. After surgery, all of the recipients in groups 1, 2, and 3 survived more than 4 days, except for one pig in group 3 that died of bleeding from an arterial catheter on day 2. By contrast, all of the recipients in group 4 died within 12 hr. The serum glutamic oxaloacetic transaminase concentration at 4 hr after reperfusion of the graft was significantly higher in group 4 (mean+/-SE, 2563+/-556 IU/L) than in groups 1, 2, and 3 (298+/-29 IU/L, 1226+/-222 IU/L, and 1181+/-174 IU/L, respectively). The adenylate energy charge of the liver graft recovered at 1 hr after reperfusion of the graft to 0.852+/-0.013, 0.845+/-0.003, and 0.842+/-0.003 in groups 1, 2, and 3, respectively. The recovery was significantly suppressed in group 4 (0.796+/-0.011). The hepatic adenosine triphosphate concentration also was significantly lower in group 4 compared with the other groups. The present study suggests that liver allografts can be used from non-heart-beating donors subjected to warm ischemia for less than 60 min. Postoperative survival is associated with prompt recovery of the adenylate energy charge of the liver graft.
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Affiliation(s)
- Y Takada
- Department of Surgery, Institute of Clinical Medicine, Tsukuba University, Ibaraki, Japan
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Tabet J, García-Valdecasas JC, Rull R, Valero R, Angás J, González FX, Cifuentes A, García F, Beltran J, Ordi J, Deulofeu R, Elena M, Cabrer C, Visa J. Non-heart-beating donor pigs: the feasibility of liver donation. Transplant Proc 1997; 29:1374-5. [PMID: 9123345 DOI: 10.1016/s0041-1345(96)00601-x] [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: 02/04/2023]
Affiliation(s)
- J Tabet
- Hospital Clinic of Barcelona, Spain
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Tojimbara T, Winston WN, So SK, Esquivel CO. Orthotopic liver transplantation from non-heart-beating donor rats: effect of flushing with cold/warm UW/SLS preservation solutions. Transplant Proc 1997; 29:1371-3. [PMID: 9123344 DOI: 10.1016/s0041-1345(96)00600-8] [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: 02/04/2023]
Affiliation(s)
- T Tojimbara
- Dept of Surgery, Tokyo Women's Medical College, Japan
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