Preservation of the liver graft with Celsior solution

INTRODUCTION

We studied the evolution of the liver graft with preservation in Celsior (CS) compared with University of Wisconsin solution (UW).

MATERIAL AND METHODS

A randomized prospective clinical study in 80 liver transplants (OLTs) from May 2001 to October 2003, compared CS (group I; n = 40) and UW (group II; n = 40). The characteristics of the donors were homogeneous, with no significant differences in 15 variables. CS was perfused with 4 L through the aorta, 2 L through the portal vein, and 1 L, through the portal vein on the back table; and the UW, as 3 L, 2 L, and 1 L, respectively. All OLTs were performed using the piggyback technique.

RESULTS

Group I experienced reperfusion syndrome (n = 2; 5.9%), primary graft nonfunction (n = 0); vascular complications (n = 0); biliary anastomosis stenosis (n = 8; 22.9%), intensive care unit (ICU) days (n = 4.1 +/- 1), death within 30 days (n = 1; 3.1%). The patient and graft survivals at 1, 3, 6, 12, and 24 months were 93.7%, 93.7%, 90.2%, 85.7%, 85.7%, and 94.3%, 88.5%, 85.2%, 78%, 78%, respectively. For group II; the reperfusion syndrome occured in 6 patients (17.6%); primary graft nonfunction (n = 0); vascular complications (n = 0), biliary anastomosis stenosis (n = 3; 8.6%), ICU days (n = 4.9 +/- 2.4) and death within 30 days (n = 1; 3.1%); The patient and graft survival at 1, 3, 6, 12, and 24 months were 96.9%, 93.5%, 89.8%, 79.8%, 79.8% and 94.3%, 88.3%, 84.9%, 75.5%, 66.1%, respectively.

CONCLUSIONS

CS offers the similar safety to UW for preservation of liver grafts within these ischemia times.

Liver transplant, in emergency 0 (UNOS Status 1)

INTRODUCTION

The emergency 0 (UNOS status 1) liver transplant (OLT) constitutes a challenge to the transplant team. The precarious condition of the patient and the use, sometimes forced by the instability of the patients, of marginal or different blood type grafts leads to worse results than in nonemergency OLT. Herein we have presented our experience with emergency 0 OLT in the first 5 years of our program.

PATIENTS AND METHODS

Among the 167 OLTs performed in the first 5 years of our program, 10 were emergency 0 OLTs. The patients were transplanted within 72 hours of inclusion on the waiting list, seven within 24 hours. The indications for emergency OLT were fulminant liver failure (FLF) in six and graft failure in the first week post-OLT in four.

RESULTS

All OLTs were performed with preservation of the vena cava (piggyback) and without venovenous bypass. There was 100% patient survival of those who required an emergency 0 OLT (follow-up period of 3 to 7 years). The graft survival in FLF was 50%. Emergency retransplant was necessary because of acute rejection due to ABO incompatibility in two patients, and due to arterial ischemia in another patient. The emergency retransplants were all successful.

CONCLUSION

In our experience the emergency 0 OLT is a formidable challenge for the team, but we achieved a patient survival comparable to or even better than that of OLT for chronic liver disease.

Treatment of Cutaneous Infection by Alternaria alternata With Voriconazole in a Liver Transplant Patient

Alternaria alternata is a dematiaceous mold capable of causing systemic and dermatological infections in immunosuppressed patients. We present a case of a liver transplant patient with cutaneous alternariosis and no response to amphotericin B lipid or surgical debridement of the lesions. Treatment with intravenous voriconazole was initiated, followed by the oral protocol, with complete resolution of the lesions. Voriconazole is an efficient alternative for the treatment of cutaneous lesions produced by A alternata.

[Evaluation of intravenous ranitidine and omeprazole effect on the 24-hour gastric ph-metry in duodenal ulcer hemorrhage]

BACKGROUND

The pharmacotherapy of bleeding peptic ulcer is directed to improve the environment of the bleeding point by keeping the gastric pH above the proteolytic range for pepsin.

OBJECTIVE

To evaluate the best pharmacological approach to inhibit gastric acid secretion with current antisecretory drugs in patients with bleeding duodenal ulcers.

METHODS

Forty-seven patients with bleeding duodenal ulcers were randomized to receive I.V.: I) Omeprazole: an initial bolus of 80 mg + perfusion of 3.3 mg/h; II) Omeprazole: an initial bolus of 80 mg + 40 mg/12 h; III) Omeprazole: 40 mg/8 h; IV) Ranitidine: perfusion of 12.5 mg/h; V) Ranitidine: 50 mg/4 h. Gastric acidity was measured and recorded by 24 h gastric pH monitoring.

RESULTS

All types of treatment with omeprazole were superior to either continuous perfusion or intermittent bolus of ranitidine in increasing the pH for 24 h and reducing the % of time the gastric pH was below 4 and 6, and the number of time the gastric pH was below 4 for more than 5 min. There were no statistical differences between the different regimens of omeprazole, but continuous perfusion of ranitidine was superior to intermittent ranitidine bolus.

CONCLUSIONS

Parenteral omeprazole is better than parenteral ranitidine in keeping the intragastric pH above the proteolytic range for pepsin in patients with bleeding duodenal ulcers.

Changes of the fibrinolytic system in liver dysfunction: role of portal hypertension

The contribution of hemodynamic changes to the pathogenesis of accelerated fibrinolysis in liver disease was investigated in rats. In animals with hepatic lesions induced by a 7-week inhalation of carbon tetrachloride there was a significant increase in blood t-PA activity and PAI activity, with no significant change in portal pressure. Following a 10-min portal vein occlusion there was a marked increase in portal pressure and t-PA activity and a significant decrease in PAI activity. Following ligation of both portal vein and hepatic artery, t-PA activity increased to a higher extent and PAI activity was reduced to a lesser extent than changes found in portal-stenosed rats. Our data suggest that high t-PA circulating levels in liver disease could be related not only to the reduced t-PA clearance as a consequence of liver injury but also to hemodynamic changes.