1
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Chen Z, Hong X, Huang S, Wang T, Ma Y, Guo Y, Huang C, Zhao Q, Guo Z, He X, Ju W, Chen M. Continuous Normothermic Machine Perfusion for Renovation of Extended Criteria Donor Livers Without Recooling in Liver Transplantation: A Pilot Experience. Front Surg 2021; 8:638090. [PMID: 34109206 PMCID: PMC8180843 DOI: 10.3389/fsurg.2021.638090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Ischemia injury affects the recovery of liver allograft function. We propose a novel technique aimed at avoiding a second ischemic injury: transplanting an extended criteria donor (ECD) liver directly under normothermic machine perfusion (NMP) without recooling. We studied two cases to evaluate the efficacy and safety of this technique. Methods: The perioperative characteristics and postoperative outcomes of two recipients of ECD livers were analyzed. Both transplantations were performed with continuous normothermic machine perfusion without recooling. Result: In case 1, the cause of donor death was anoxia, and the donor liver had hypernatremia before procurement. The recipient was diagnosed with decompensated cirrhosis. His model for end-stage liver disease (MELD) score was 38. In case 2, the donor liver was from a donor after cardiac death (DCD), and the donor had elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. The recipient was diagnosed with acute hepatic failure. His MELD score was 35. Both donor livers were maintained under NMP and then transplanted without recooling. The peak ALT and AST levels after surgery were 452 and 770 U/L in case 1 and 100 and 592 U/L in case 2. Neither early allograft dysfunction (EAD) nor primary graft non-function (PNF) was present in these two cases. Conclusion: In conclusion, our results demonstrate that continuous NMP without recooling is efficacious and safe for LT with extended criteria donor livers. Further investigations of this technique will be performed to confirm these promising results.
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Affiliation(s)
- Zhitao Chen
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Xitao Hong
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Shanzhou Huang
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, School of Medicine, South China University of Technology, Guangzhou, China
| | - Tielong Wang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Yihao Ma
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Yiwen Guo
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Changjun Huang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Qiang Zhao
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Zhiyong Guo
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Xiaoshun He
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Weiqiang Ju
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Maogen Chen
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
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2
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Nakamura K, Kageyama S, Kaldas FM, Hirao H, Ito T, Kadono K, Dery KJ, Kojima H, Gjertson DW, Sosa RA, Kujawski M, Busuttil RW, Reed EF, Kupiec-Weglinski JW. Hepatic CEACAM1 expression indicates donor liver quality and prevents early transplantation injury. J Clin Invest 2021; 130:2689-2704. [PMID: 32027621 DOI: 10.1172/jci133142] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/30/2020] [Indexed: 12/16/2022] Open
Abstract
Although CEACAM1 (CC1) glycoprotein resides at the interface of immune liver injury and metabolic homeostasis, its role in orthotopic liver transplantation (OLT) remains elusive. We aimed to determine whether/how CEACAM1 signaling may affect hepatic ischemia-reperfusion injury (IRI) and OLT outcomes. In the mouse, donor liver CC1 null mutation augmented IRI-OLT (CC1-KO→WT) by enhancing ROS expression and HMGB1 translocation during cold storage, data supported by in vitro studies where hepatic flush from CC1-deficient livers enhanced macrophage activation in bone marrow-derived macrophage cultures. Although hepatic CC1 deficiency augmented cold stress-triggered ASK1/p-p38 upregulation, adjunctive ASK1 inhibition alleviated IRI and improved OLT survival by suppressing p-p38 upregulation, ROS induction, and HMGB1 translocation (CC1-KO→WT), whereas ASK1 silencing (siRNA) promoted cytoprotection in cold-stressed and damage-prone CC1-deficient hepatocyte cultures. Consistent with mouse data, CEACAM1 expression in 60 human donor liver biopsies correlated negatively with activation of the ASK1/p-p38 axis, whereas low CC1 levels associated with increased ROS and HMGB1 translocation, enhanced innate and adaptive immune responses, and inferior early OLT function. Notably, reduced donor liver CEACAM1 expression was identified as one of the independent predictors for early allograft dysfunction (EAD) in human OLT patients. Thus, as a checkpoint regulator of IR stress and sterile inflammation, CEACAM1 may be considered as a denominator of donor hepatic tissue quality, and a target for therapeutic modulation in OLT recipients.
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Affiliation(s)
- Kojiro Nakamura
- Department of Surgery, Division of Liver and Pancreas Transplantation, Dumont-UCLA Liver Transplant Center
| | - Shoichi Kageyama
- Department of Surgery, Division of Liver and Pancreas Transplantation, Dumont-UCLA Liver Transplant Center
| | - Fady M Kaldas
- Department of Surgery, Division of Liver and Pancreas Transplantation, Dumont-UCLA Liver Transplant Center
| | - Hirofumi Hirao
- Department of Surgery, Division of Liver and Pancreas Transplantation, Dumont-UCLA Liver Transplant Center
| | - Takahiro Ito
- Department of Surgery, Division of Liver and Pancreas Transplantation, Dumont-UCLA Liver Transplant Center
| | - Kentaro Kadono
- Department of Surgery, Division of Liver and Pancreas Transplantation, Dumont-UCLA Liver Transplant Center
| | - Kenneth J Dery
- Department of Surgery, Division of Liver and Pancreas Transplantation, Dumont-UCLA Liver Transplant Center
| | - Hidenobu Kojima
- Department of Surgery, Division of Liver and Pancreas Transplantation, Dumont-UCLA Liver Transplant Center
| | - David W Gjertson
- Department of Biostatistics, UCLA School of Public Health.,Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rebecca A Sosa
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Maciej Kujawski
- Department of Molecular Immunology, Beckman Research Institute of City of Hope, Duarte, California, USA
| | - Ronald W Busuttil
- Department of Surgery, Division of Liver and Pancreas Transplantation, Dumont-UCLA Liver Transplant Center
| | - Elaine F Reed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jerzy W Kupiec-Weglinski
- Department of Surgery, Division of Liver and Pancreas Transplantation, Dumont-UCLA Liver Transplant Center
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3
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Ju W, Chen Z, Zhao Q, Zhang Y, Huang C, Wang L, Zhu C, Chen Y, Guo Z, Chen M, He X. Non-re-cooling implantation of marginal liver graft after machine perfusion: report of a case. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1465. [PMID: 33313210 PMCID: PMC7723619 DOI: 10.21037/atm-20-2774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Early allograft dysfunction (EAD), primary graft nonfunction (PNF) and biliary complications affect postoperative survival after liver transplantation (LT). Ischemia injury is one of the major factors affecting liver allograft functional recovery. Ischemia-free liver transplantation (IFLT) has obvious advantages for the recovery of allograft function and complication incidence compared with conventional procedures. However, its use is limited when the donor and the recipient are not in the same hospital and donors should be donor after brain death (DBD). We propose an approach to avoid double warm ischemic injury by implanting marginal donor liver directly by using normothermic machine perfusion (NMP) without re-cooling. Here, we report the first case of non-re-cooling implantation for marginal donor in LT. Donor liver biopsies before procurement showed 50% macrovesicular steatosis, and the recipient was a 67-year-old man with decompensated cirrhosis secondary to a 21-year hepatitis B virus (HBV) infection. The donor liver was maintained by NMP without re-cooling before implantation. The highest levels of alanine transaminase (ALT) and aspartate transaminase (AST) after surgery were 235 and 1,076 U/L, respectively, on the first postoperative day (POD). The patient was discharged within 2 weeks and showed good recovery. Thus, it is feasible to use Non-re-cooling implantation for marginal donor in LT.
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Affiliation(s)
- Weiqiang Ju
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Zhitao Chen
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Qiang Zhao
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Yixi Zhang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Changjun Huang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Linhe Wang
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Caihui Zhu
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Yinghua Chen
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Zhiyong Guo
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Maogen Chen
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Xiaoshun He
- Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
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4
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di Francesco F, Pagano D, Martucci G, Cintorino D, Gruttadauria S. Normothermic Machine Perfusion in Liver Transplantation: Feasibility and Promise of Avoiding Recooling Before Engrafting. Liver Transpl 2019; 25:1113-1117. [PMID: 31002466 DOI: 10.1002/lt.25473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 04/11/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Fabrizio di Francesco
- Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Duilio Pagano
- Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Davide Cintorino
- Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center Italy, Palermo, Italy
| | - Salvatore Gruttadauria
- Abdominal Surgery and Organ Transplantation Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center Italy, Palermo, Italy.,University of Catania, Catania, Italy
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5
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Guo T, Lei J, Gao J, Li Z, Liu Z. The hepatic protective effects of tacrolimus as a rinse solution in liver transplantation: A meta-analysis. Medicine (Baltimore) 2019; 98:e15809. [PMID: 31124980 PMCID: PMC6571202 DOI: 10.1097/md.0000000000015809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Tacrolimus was used as a rinse solution against ischaemia-reperfusion injury (IRI) in liver transplantation for years but its protective effects remain controversies. METHODS We conducted literature retrieval in electronic databases including MEDLINE, EMBASE and Cochrane Central to identify relevant randomized controlled trials (RCTs) investigating the effects of tacrolimus as a rinse solution in liver transplantation. Postoperative liver function, including alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL), at postoperative day (POD) 1, 2 and 7 was extracted for pooled estimation. Forest plots were generated to calculate the differences between the groups. The I2 index statistic was used to assess heterogeneity. Publication bias was evaluated using funnel plots and Egger's test. RESULTS Three RCTs including 70 liver transplants were evaluated in this study. Pooled estimation revealed that rinse with tacrolimus in liver transplantation did not provide hepatic protection with respect to postoperative ALT (Test Z = 1.36; P = .175), AST (Test Z = 1.70; P = .090) or TBIL (Test Z = 0.69; P = .490). Sensitivity analysis by excluding extended donor criteria (EDC) livers showed similar results. Funnel plots and Egger's test demonstrated that there was no substantial bias. CONCLUSION We may tentatively conclude that tacrolimus is ineffective for amelioration of postoperative liver function as a rinse solution in liver transplantation. Nevertheless, there is great space for future research in this area, and the potential clinical value of tacrolimus needs to be further addressed. We are expecting more evidence to support our speculations.
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Affiliation(s)
- Tao Guo
- Department of Hepatobiliary and Pancreatic Surgery, Department of General Surgery
| | - Junhao Lei
- Department of Urology Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Jiamin Gao
- Department of Emergency, Huashan Hospital, Fudan University, Shanghai, P.R. China
| | - Zhen Li
- Department of Hepatobiliary and Pancreatic Surgery, Department of General Surgery
| | - Zhisu Liu
- Department of Hepatobiliary and Pancreatic Surgery, Department of General Surgery
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6
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Brisson H, Arbelot C, Monsel A, Parisot C, Girard M, Savier E, Vezinet C, Lu Q, Vaillant JC, Golmard JL, Gorochov G, Langeron O, Rouby JJ. Impact of graft preservation solutions for liver transplantation on early cytokine release and postoperative organ dysfunctions. A pilot study. Clin Res Hepatol Gastroenterol 2017; 41:564-574. [PMID: 28330599 DOI: 10.1016/j.clinre.2016.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/23/2016] [Accepted: 12/28/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION During liver transplantation, graft ischemia-reperfusion injury leads to a systemic inflammatory response producing postoperative organ dysfunctions. The aim of this observational and prospective study was to compare the impact of Solution de conservation des organes et tissus (SCOT) 15 and University of Wisconsin (UW) preservation solutions on early cytokine release, postreperfusion syndrome and postoperative organ dysfunctions. METHODS Thirty-seven liver transplantations were included: 21 in UW Group and 16 in SCOT 15 group. Five cytokines were measured in systemic blood after anesthetic induction, 30minutes after unclamping portal vein and on postoperative day 1. RESULTS Following unclamping portal vein, cytokines were released in systemic circulation. Systemic cytokine concentrations were higher in UW than in SCOT 15 group: Interleukin-10, Interleukine-6. In SCOT 15 group, significant reduction of postreperfusion syndrome incidence and acute kidney injury were observed. Alanine and aspartate aminotransferase peak concentrations were higher in SCOT 15 group than in UW group. However, from postoperative day 1 to day 10, aminotransferase returned to normal values and did not differ between groups. CONCLUSIONS Compared to UW, SCOT 15 decreases systemic cytokine release resulting from graft ischemia-reperfusion injury and reduces incidence of postreperfusion syndrome and postoperative renal failure.
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Affiliation(s)
- H Brisson
- Department of Anesthesiology and Critical Care Medicine, Multidisciplinary Intensive Care Unit, AP-HP, La Pitié-Salpêtrière Hospital, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France(1); UMR-S 945, La Pitié-Salpêtrière Hospital, Institut national de la santé et de la recherche médicale, AP-HP, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France.
| | - C Arbelot
- Department of Anesthesiology and Critical Care Medicine, Multidisciplinary Intensive Care Unit, AP-HP, La Pitié-Salpêtrière Hospital, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France(1)
| | - A Monsel
- Department of Anesthesiology and Critical Care Medicine, Multidisciplinary Intensive Care Unit, AP-HP, La Pitié-Salpêtrière Hospital, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France(1)
| | - C Parisot
- UMR-S 945, La Pitié-Salpêtrière Hospital, Institut national de la santé et de la recherche médicale, AP-HP, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France
| | - M Girard
- Department of Anesthesiology and Critical Care Medicine, Multidisciplinary Intensive Care Unit, AP-HP, La Pitié-Salpêtrière Hospital, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France(1)
| | - E Savier
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, AP-HP, La Pitié-Salpêtrière Hospital, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France; Inserm, U1082, plateform IBISA, université de Poitiers, faculté de médecine et de pharmacie, 86021 Poitiers, France
| | - C Vezinet
- Department of Anesthesiology and Critical Care Medicine, Multidisciplinary Intensive Care Unit, AP-HP, La Pitié-Salpêtrière Hospital, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France(1)
| | - Q Lu
- Department of Anesthesiology and Critical Care Medicine, Multidisciplinary Intensive Care Unit, AP-HP, La Pitié-Salpêtrière Hospital, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France(1)
| | - J-C Vaillant
- Department of Digestive and Hepato-Pancreato-Biliary Surgery, AP-HP, La Pitié-Salpêtrière Hospital, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France
| | - J-L Golmard
- ER4 "Modélisation en recherche clinique", université Paris 06, université Pierre-et-Marie-Curie et UF de biostatistique, La Pitié-Salpêtrière Hospital, 75013 Paris, France
| | - G Gorochov
- UMR-S 945, La Pitié-Salpêtrière Hospital, Institut national de la santé et de la recherche médicale, AP-HP, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France
| | - O Langeron
- Department of Anesthesiology and Critical Care Medicine, Multidisciplinary Intensive Care Unit, AP-HP, La Pitié-Salpêtrière Hospital, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France(1)
| | - J-J Rouby
- Department of Anesthesiology and Critical Care Medicine, Multidisciplinary Intensive Care Unit, AP-HP, La Pitié-Salpêtrière Hospital, université Paris 06, université Pierre-et-Marie-Curie, 75013 Paris, France(1)
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7
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Yassen AM, Elsarraf WR, Elmorshedi MA, Abdel Wahab M, Salah T, Sultan AM, Elghawalby AN, Elshobari MM, Elsadany M, Zalata K, Shiha U. Short-term effects of extracorporeal graft rinse versus circulatory graft rinse in living donor liver transplantation. A prospective randomized controlled trial. Transpl Int 2017; 30:725-733. [PMID: 28403531 DOI: 10.1111/tri.12968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/12/2016] [Accepted: 04/06/2017] [Indexed: 12/20/2022]
Abstract
Living donor liver transplantation has shorter cold ischemia time, less preservative volume, and lower metabolic load compared to transplantation from deceased donors. We investigated the impact of rinsing the graft contents into the systemic circulation on operative course and postoperative outcomes. Donors had right hepatectomy, and grafts were preserved with cold histidine-tryptophan-ketoglutarate solution. On ending portal vein anastomosis, grafts were flushed by patient's portal blood either through incompletely anastomosed hepatic vein (extracorporeal rinse group, EcRg, n = 40) or into systemic circulation (circulatory rinse group, CRg, n = 40). The primary outcome objective was the lowest mean arterial blood pressure within 5 min after portal unclamping as a marker for postreperfusion syndrome (PRS). Secondary objectives included hemodynamics and early graft's and patient's outcomes. Within 5 min postreperfusion, mean arterial blood pressure was significantly lower in the CRg compared to the EcRg, yet this was clinically insignificant. Postoperative graft functions, early biliary and vascular complications, and three-month survival were comparable in both groups. Rinsing the graft into the circulation increased the incidence of PRS without significant impact on early graft or patient outcome in relatively healthy recipients.
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Affiliation(s)
- Amr M Yassen
- Department of Anesthesia and Intensive Care, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Waleed R Elsarraf
- Department of Anesthesia and Intensive Care, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Mohamed A Elmorshedi
- Department of Anesthesia and Intensive Care, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Mohamed Abdel Wahab
- Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Tarek Salah
- Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Ahmed M Sultan
- Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Ahmed N Elghawalby
- Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Mohamed M Elshobari
- Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Mohamed Elsadany
- Department of Hepatology, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Khaled Zalata
- Department of Pathology, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt
| | - Usama Shiha
- Department of Radiology, Gastroenterology Surgical Center, Mansoura University, Mansoura, Dakahlia, Egypt
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8
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Shah R, Gutsche JT, Patel PA, Fabbro M, Ochroch EA, Valentine EA, Augoustides JGT. CASE 6-2016Cardiopulmonary Bypass as a Bridge to Clinical Recovery From Cardiovascular Collapse During Graft Reperfusion in Liver Transplantation. J Cardiothorac Vasc Anesth 2015; 30:809-15. [PMID: 26738978 DOI: 10.1053/j.jvca.2015.08.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Ronak Shah
- Cardiovascular and Thoracic Section Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Cardiovascular and Thoracic Section Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael Fabbro
- Cardiovascular and Thoracic Section Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Edward A Ochroch
- Liver Transplant Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth A Valentine
- Liver Transplant Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G T Augoustides
- Cardiovascular and Thoracic Section Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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