1
|
Palenciano CG, Acosta F, Segura B, Sansano T, Ramírez P, Fernandez-Rodriguez O, Majado M, Ríos A, Munoz A, Robles R, Bueno FS, Parrilla P. Hemodynamic changes during reperfusion of the graft in an animal model of liver xenotransplantation. Transplant Proc 2007; 39:2441-2. [PMID: 17889213 DOI: 10.1016/j.transproceed.2007.06.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED Our goal was to determine the hemodynamic changes that are witnessed during the initial minutes of reperfusion of the graft in liver xenotransplantation from pig to baboon. METHOD We studied a group of 12 baboons undergoing transplantation of a pig liver via the classic technique with arterial anastomosis to the aorta. The anesthesia technique was similar to that used in humans. Hemodynamic monitoring, due to the size of the recipient, consisted of heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP) recorded at the beginning and end of each of the three phases: preanhepatic (A1, A2), anhepatic (B1, B2), and neohepatic (C1 and C2). We aimed to maintain the following values by means of crystalloids, colloids, and blood derivates: HR >50 beats/minute; MAP >60 mm Hg; and CVP >10 mm Hg. RESULTS Both HR and CVP remained unchanged throughout the procedure. MAP droped briefly after vascular clamping (B1) but not on reperfusion (C1). CONCLUSION In cirrhotic patients there is an autonomic dysfunction, demonstrated as cardiovascular instability at times like the clamping of major vessels and reperfusion of the graft. On the other hand, the intact baboon has an intact nervous system. After vascular clamping, the sharp decrease in venous return lead to an adequate vasopressor response. Likewise, the extreme vasodilatation involved with reperfusion managed to maintain MAP above 70 mm Hg.
Collapse
Affiliation(s)
- C G Palenciano
- Liver Transplant Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Fernández-Rodríguez OM, Palenciano CG, Ríos A, Martínez L, Arance M, Segura B, Martín-Gil R, Conesa C, Sansano T, Acosta F, Ramírez P, Parrilla P. Hemodynamic Assessment During Auxiliary Heterotopic Liver Transplantation With Portal Vein Arterialization in a Swine Model: Preliminary Report of 10 Transplants. Transplant Proc 2006; 38:2603-5. [PMID: 17098014 DOI: 10.1016/j.transproceed.2006.08.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED Portal vein arterialization (PVA) is a technical variation of auxiliary heterotopic liver transplantation (AHLT) that is rarely studied but that simplifies the AHLT surgical technique because it does not act on the portal area. The objective of this study was to analyze the hemodynamic consequences of this auxiliary transplant in an experimental model. MATERIALS AND METHODS Ten AHLT-PVA were analyzed in a pig model. A PiCCO (Pulsion) monitor was used for the hemodynamic study of the recipient. The following were measured: cardiac index, (CI), systemic vascular resistance index, (SVRI), mean arterial pressure (MAP), global end-diastolic volume, central venous pressure, and intrathoracic blood volume. The measurements were taken at four times during transplant: at baseline, after inferior vena cava clamping, after graft reperfusion, and at closure. RESULTS After graft reperfusion there was a reduction in SVRI (968 +/- 168.03 vs 1686.25 +/- 290.66; P < .05) and in MAP, and there was an increase in CI. At the end of the transplant MAP and SVRI recovered (1254.2 +/- 225.79 vs 968 +/- 168.03; P < .05) but CI remained slightly high. The end-diastolic volume showed greater variation than central venous pressure, although this was only statistically significant at the inferior vena cava clamping phase (244.75 +/- 52.05 vs 333.37 +/- 170.13; P < .05). DISCUSSION Heterotopic liver transplantation with portal arterialization is well-tolerated hemodynamically. Graft reperfusion decreases SVRI and increases CI to compensate for this. This behavior, which in healthy recipients like ours is not a problem, could imply a contraindication in patients with a prior hyperdynamic state.
Collapse
Affiliation(s)
- O M Fernández-Rodríguez
- Unit of Experimental Surgery, Departament of Surgery, Arrixaca University Hospital, 30120 El Palmar, Murcia, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Cabezuelo JB, Ramírez P, Ríos A, Acosta F, Torres D, Sansano T, Pons JA, Bru M, Montoya M, Bueno FS, Robles R, Parrilla P. Risk factors of acute renal failure after liver transplantation. Kidney Int 2006; 69:1073-80. [PMID: 16528257 DOI: 10.1038/sj.ki.5000216] [Citation(s) in RCA: 213] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The objective of this study was to determine the risk factors of postoperative acute renal failure (ARF) in orthotopic liver transplantation (OLT). We reviewed 184 consecutive OLT. Postoperative ARF was defined as a persistent rise of 50% increase or more of the S-creatinine (S-Cr). The patients were classified as early postoperative ARF (E-ARF) (first week) and late postoperative ARF (L-ARF) (second to fourth week). Preoperative variables were age, sex, comorbidity, indication for OLT, Child-Pugh stage, united network for organ sharing status, analysis of the blood and urine, and donor's data. Intraoperative variables were systolic arterial pressure, mean arterial pressure, pulmonary capillary wedge pressure, cardiac index, and systemic vascular resistance index. Surgical technique, number of blood products transfused, need for adrenergic agonist drugs, and intraoperative complications were also important. Postoperative variables were duration of stay in the intensive care unit, time on mechanic ventilation, liver graft dysfunction, need for adrenergic agonist drugs, units of blood products infused, episodes of acute rejection, re-operations, and bacterial infections. Firstly we carried out a univariate statistical analysis, and secondly a logistic regression analysis. The risk factors for E-ARF were: pretransplant ARF (odds ratio (OR)=10.2, P=0.025), S-albumin (OR=0.3, P=0.001), duration of treatment with dopamine (OR=1.6, P=0.001), and grade II-IV dysfunction of the liver graft (OR=5.6, P=0.002). The risk factors for L-ARF were: re-operation (OR=3.1, P=0.013) and bacterial infection (OR=2.9, P=0.017). The development of E-ARF is influenced by preoperative factors such as ARF and hypoalbuminemia, as well as postoperative factors such as liver dysfunction and prolonged treatment with dopamine. The predicting factors of L-ARF differ from E-ARF and correspond to postoperative causes such as bacterial infection and surgical re-operation.
Collapse
Affiliation(s)
- J B Cabezuelo
- Nephrology Unit, Santa María del Rosell Hospital, Cartagena, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Acosta F, Sansano T, Palenciano CG, Domenech P, Falcon L, Robles R, Bueno FS, Ramirez P, Parrilla P. Differential response of the systemic and pulmonary circulation related to disease severity of cirrhosis. Transplant Proc 2006; 37:3889-90. [PMID: 16386574 DOI: 10.1016/j.transproceed.2005.10.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND In cirrhotic patients, the degree of hepatic insufficiency has been related to a physiological landmark: arterial vasodilatation. We sought to assess how the severity of disease, which was stratified according to the Child-Pugh criteria, influences the pulmonary and systemic circulation among patients undergoing liver transplantation. METHODS We studied 86 cirrhotic patients in three groups: grade A (n = 10), grade B (n = 54), and grade C (n = 22). The outurnes were classified based upon a complete hemodynamic profile obtained using a pulmonary artery catheter (RVEF, Baxter-Edwards, Calif, USA) after induction of anesthesia. The variables were mean arterial and pulmonary artery pressures and cardiac index (CI). Using standard formulae, afterload was calculated as elastance of systemic (Es) and pulmonary (Ep) arterial beds, expressed by the ratio of end-systolic pressure to stroke volume. The relation between pulmonary and systemic circulation was also evaluated by the ratio (Ep/Es). RESULTS Es was significantly lower in each class than in previous one. Also, Ep was smaller in class B than in class C patients. In addition, CI was significantly higher with disease severity. CONCLUSION We observed that the hyperdynamic circulation in cirrhosis is directly related to severity of disease. Nevertheless Ep/Es was progressively higher among each group; these data suggest that the hyperdynamic circulation is mainly due to circulatory alterations in the splanchnic area. We conclude that pulmonary vasodilatation is directly related to the severity of cirrhosis, although its evolution is independent of other vascular areas.
Collapse
Affiliation(s)
- F Acosta
- Liver Transplantation Unit, University Hospital V, Arrixaca, Murcia, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Ramírez P, Montoya MJ, Ríos A, García Palenciano C, Majado M, Chávez R, Muñoz A, Fernández OM, Sánchez A, Segura B, Sansano T, Acosta F, Robles R, Sánchez F, Fuente T, Cascales P, González F, Ruiz D, Martínez L, Pons JA, Rodríguez JI, Yélamos J, Cowan P, d'Apice A, Parrilla P. Prevention of hyperacute rejection in a model of orthotopic liver xenotransplantation from pig to baboon using polytransgenic pig livers (CD55, CD59, and H-transferase). Transplant Proc 2006; 37:4103-6. [PMID: 16386637 DOI: 10.1016/j.transproceed.2005.09.186] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The search for alternative sources for transplant organs leads us to the search for animals as an inexhaustible source of organs. The objective of this study was to analyze whether livers from polytransgenic pigs expressing the human complement regulatory proteins CD55 (hDAF), CD59, and alfa alpha1,2-fucosyltransferase (H-transferase), protected against hyperacute rejection after orthotopic liver xenotransplantation to a baboon and also to study pig liver function in a nonhuman primate. MATERIALS AND METHODS Nine liver transplants from pig to baboon were divided into two groups: a control group (n = 4) of genetically unmodified pigs and an experimental group (n = 5) of pigs transgenic for CD55, CD59, and H-transferase as donors. All the donating piglets obtained through hysterectomy were maintained in specific pathogen-free conditions. The selection of transgenic pig donors followed demonstration of transgene expression using monoclonal antibodies (antiCD55, antiCD59) and immunohistological studies on liver biopsies. RESULTS All animals in the control group developed hyperacute rejection with survival rates less than 16 hours without function of transplanted livers. In the experimental group none of the animals suffered hyperacute rejection. Survival in this group was between 13 and 24 hours. The livers were functional, producing bile and maintaining above 35% prothrombin activity. Only in one case was there primary dysfunction of the xenograft. CONCLUSION Polytransgenic livers for complement regulatory proteins prevent hyperacute rejection when xenotransplanted into a baboon.
Collapse
Affiliation(s)
- P Ramírez
- Liver Transplant Unit, Department of Surgery, Virgen Arrixaca University Hospital, Murcia, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Acosta F, Sansano T, Palenciano CG, Falcón L, Doménech P, Robles R, Bueno FS, Ramírez P, Parrilla P. Effects of rapid paracentesis on right ventricular-arterial coupling in liver transplantation. Transplant Proc 2006; 37:3867-8. [PMID: 16386566 DOI: 10.1016/j.transproceed.2005.10.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In cirrhotic patients intra-abdominal pressure (IAP) changes markedly modify splanchnic and systemic hemodynamics. Previous studies have evaluated the effects of increased IAP on steady-state cardiac performance, showing that right ventricular (RV) function becomes more depressed than that of the left ventricular. We sought to evaluate the effects of paracentesis on RV function and ventricular-arterial coupling among cirrhotics undergoing liver transplantation (OLT). METHODS Twelve cirrhotic patients undergoing OLT underwent hemodynamic profiles before and 5 minutes after paracentesis, employing a right ventricular ejection fraction catheter in the pulmonary artery. We studied heart rate, systolic pulmonary artery pressure, central venous pressure (CVP), stroke volume index (SVI), RV end-diastolic volume index (RVEDI), and RV ejection fraction. In addition RV stroke work index (RVSWI), RV end-diastolic compliance (RVEDC), RV end-systolic elastance (Ees), pulmonary artery effective elastance (Ea), and RV coupling efficiency (Ees/Ea ratio) were calculated employing standard formulas. RESULTS After removal of mean ascites volume of 5.6 +/- 2.2 L (range 4.0 to 8.04 L), SVI, RVEDI, RVSWI, and RVEDC were significantly increased and conversely CVP, Ees, and Ea were decreased with an ea/ea ratio unchanged. CONCLUSIONS Before paracentesis Ees/Ea is preserved by increased of RV contractility; after paracentesis the coupling was maintained.
Collapse
Affiliation(s)
- F Acosta
- Liver Transplantation Unit, University Hospital V, Arrixaca, Murcia, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Acosta F, Sansano T, Palenciano CG, Falcon L, Domenech P, Robles R, Bueno FS, Ramirez P, Parrilla P. Effects of Dobutamine on Right Ventricular Function and Pulmonary Circulation in Pulmonary Hypertension During Liver Transplantation. Transplant Proc 2005; 37:3869-70. [PMID: 16386567 DOI: 10.1016/j.transproceed.2005.10.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In the setting of orthotopic liver transplantation (OLT), pulmonary hypertension (PH) affects right ventricular (RV) function. When RV failure occurs, reducing RV afterload, optimizing RV preload, and preserving coronary perfusion through maintenance of systemic blood pressure are the primary goals of intraoperative treatment. PATIENTS AND METHODS To verify the effect of dobutamine on RV function and RV-arterial coupling, we compared a group of 9 cirrhotic patients with mild PH treated with OLT to a group of 20 patients with normal mean pulmonary artery pressure (MPAP). All patients received dobutamine (5-10 microg/kg/min) to maintain a cardiac index (CI) >3 L/min/m(2), during the anhepatic phase. Hemodynamic profile, using a pulmonary artery catheter, was performed before and during dobutamine infusion, studying MPAP, CI, and RV end-diastolic volume index (RVEDVI). RV stroke work index (RVSWI), RV end-systolic elastance (Ees), pulmonary effective elastance (Ea), and RV-arterial coupling efficiency as the Ees/Ea ratio were also calculated. RESULTS RV contractility (Ees and RVSWI) and afterload (Ea) were significantly higher among the PH group. In both groups, all the studied variables improved with dobutamine: RV contractility increased, afterload decreased, and thus Ees/Ea coupling markedly increased. CONCLUSION Cirrhotic patients with mild PH who were undergoing OLT still have a reserve of RV contractile performance and pulmonary vasodilation.
Collapse
Affiliation(s)
- F Acosta
- Liver Transplantation Unit, University Hospital V. Arrixaca, Murcia, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Acosta F, Sansano T, Palenciano CG, Domenech P, Falcon L, Robles R, Bueno FS, Ramirez P, Parrilla P. Portopulmonary Hypertension and Liver Transplantation: Hemodynamic Consequences at Reperfusion. Transplant Proc 2005; 37:3865-6. [PMID: 16386565 DOI: 10.1016/j.transproceed.2005.10.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The absence of portopulmonary hypertension (PH) upon preoperative evaluation for liver transplantation (OLT) does not exclude the occasional occurrence of an acquired PH while awaiting a graft. We sought to estimate hemodynamic changes and right ventriculoarterial coupling during reperfusion. METHODS We studied 11 cirrhotic patients diagnosed with mild PH, according to the current classification: mean pulmonary artery pressure (MPAP)-25 to 34 mm Hg. These patients underwent OLT, using the piggyback technique (group PH). None of them had exhibited criteria for PH on preoperative echocardiography. This cohort was compared with 20 consecutive cirrhotic patients with normal MPAP at OLT. We performed a complete hemodynamic profile using a pulmonary artery catheter (RVEF, Baxter-Edwards, Calif, USA) before and 5 minutes after reperfusion. The variables were MPAP and right ventricular (RV) end-diastolic volume index (RVEDVI). Using standard formulas we calculated RV stroke work index (RVSWI), RV end-systolic elastance (Ees), pulmonary effective elastance (Ea), and RV-arterial coupling efficiency as the Ees/Ea ratio. Systolic ventricular function was expressed as RVSWI versus RVEDVI. RESULTS During the anhepatic phase, MPAP, Ees, Ea, and RVSWI were higher in the PH group; but RVEDVI was lower. After reperfusion the pressure (MPAP), contractility (RVSWI) and preload (RVEDVI) increased in both groups. However, afterload (Ea) decreased in the non-PH group; accordingly, Es/Ea increased only in these patients. DISCUSSION At reperfusion, the expansion in preload and cardiac output, without a similar afterload decrease, is responsible for the steady increase in pressure. Our results have shown that in the PH patient group, systolic ventricular function improves during reperfusion by a Frank-Starling mechanism; however, ventricular-arterial uncoupling is maintained (Ees/Ea < 1) because ventricular contractility is not appropriately balanced by simultaneous declines in afterload.
Collapse
Affiliation(s)
- F Acosta
- Liver Transplantation Unit, University Hospital V, Arrixaca, Murcia, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
BACKGROUND Cardiovascular changes during drainage of pericardial effusion are not well understood, and most studies are of systemic effects and not of right ventricular performance. Thoracoscopy is not widely used to drain pericardial effusions because of haemodynamic changes in relation to the use of single lung ventilation. PATIENTS AND METHODS We studied 16 patients undergoing partial pericardiectomy for pericardial effusion, using videothoracoscopy with a low-pressure pneumothorax (6 mm Hg). Cardiac output was measured by thermodilution with the patient anaesthetized in the supine position before the procedure; in the right lateral position after a low-pressure pneumothorax had been established; and after drainage of the pericardial effusion. RESULTS Before the procedure, cardiac output was low and central venous pressure and pulmonary artery occlusion pressure were increased. Systemic vascular resistance and arterial blood pressure were within normal limits. Cardiac filling pressure and pulmonary arterial pressure increased during the pneumothorax. After the drainage cardiac index increased and systemic and pulmonary vascular resistances were reduced. CONCLUSIONS Pericardial effusion reduces right ventricular distensibility, right and left systolic ventricular function, and cardiac output. Anaesthesia with mechanical ventilation and a low-pressure pneumothorax do not affect the circulation greatly. Drainage of the pericardial effusion allows cardiac distensibility to increase and cardiac performance changes to allow increased ejection.
Collapse
Affiliation(s)
- J A Fernández
- Servicio de Cirugía I and Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de la Arrixaca, El Palmar S/N, Murcia E-30120, Spain.
| | | | | | | | | |
Collapse
|
10
|
Cabezuelo JB, Ramirez P, Acosta F, Torres D, Sansano T, Pons JA, Bru M, Montoya M, Rios A, Sánchez Bueno F, Robles R, Parrilla P. Does the standard vs piggyback surgical technique affect the development of early acute renal failure after orthotopic liver transplantation? Transplant Proc 2003; 35:1913-4. [PMID: 12962846 DOI: 10.1016/s0041-1345(03)00598-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The objective of this study was to evaluate the effect of the surgical technique on postoperative renal function during the first week after liver transplantation (OLT). We performed a retrospective study of 184 consecutive OLT. Criteria for acute renal failure were: serum creatinine >1.5 mg/dL, an increase by 50% in the baseline serum creatinine, or oliguria requiring renal replacement therapy. The distribution of patients according to the surgical technique was: standard (n=84), venovenous bypass (n=20), and piggyback (n=80). Other variables analyzed were: intraoperative requirement for blood products, treatment with adrenergic agonists, intraoperative complications, and postreperfusion syndrome. Univariate analysis showed the following parameters to be significantly related to postoperative renal failure: intraoperative fresh frozen plasma and cryoprecipitate requirements, intraoperative complications, postreperfusion syndrome, need for noradrenaline or dobutamine, standard surgical technique versus piggyback (39% vs 18%, P<.01) and venovenous vs piggyback (50% vs 18%, P<.01). Logistic regression analysis identified the following variables as having independent prognostic value: (1) Standard surgical technique vs piggyback (OR=3.3, P=.01); (2) venovenous vs piggyback (OR=4.7, P=.02); and (3) >20 U cryoprecipitate requirement (OR=1.04, P=.01). In conclusion, compared with the piggyback technique, the standard surgical technique appears to be an independent risk factor for postoperative acute renal failure. When venovenous bypass is used in patients who do not tolerate trial clamping of inferior vena cava, it does not reduce the incidence of postoperative renal failure. Finally, the piggyback technique significantly reduces the probability of acute renal failure after liver transplantation.
Collapse
Affiliation(s)
- J B Cabezuelo
- Liver Transplant Unit, University Hospital V. Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Acosta F, Sansano T, Palenciano CG, Roqués V, Clavel N, González P, Robles R, Bueno FS, Ramírez P, Parrilla P. Does mixed venous oxygen saturation reflect the changes in cardiac output during liver transplantation? Transplant Proc 2002; 34:277. [PMID: 11959284 DOI: 10.1016/s0041-1345(01)02762-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V.Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Acosta F, Rodriguez MA, Sansano T, Palenciano CG, Roques V, Clavel N, González P, Robles R, Bueno FS, Ramirez P, Parrilla P. Influence of the basal cardiovascular state on the need for venovenous bypass during liver transplantation. Transplant Proc 2002; 34:273-4. [PMID: 11959281 DOI: 10.1016/s0041-1345(01)02759-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V. Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Acosta F, Sansano T, Palenciano CG, Roqués V, Clavel N, González P, Robles R, Bueno FS, Ramírez P, Parrilla P. Physiological changes induced by continuous arteriovenous hemodialysis during liver transplantation. Transplant Proc 2002; 34:276. [PMID: 11959283 DOI: 10.1016/s0041-1345(01)02761-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V.Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Ramirez P, Chavez R, Majado M, Munitiz V, Muñoz A, Hernandez O, Palenciano CG, Pino-Chavez G, Loba M, Minguela A, Yelamos J, Gago MR, Vizcaino AS, Asensi H, Cayuela M, Segura B, Marin F, Rubio A, Fuente T, Robles R, Bueno FS, Sansano T, Acosta F, Rodriguez JM, Rios A, Montoya M, Navarro F, Cabezuelo J, Cozzi E, White DJG, Parrilla P. Transgenic pig-to-baboon liver xenotransplantation: clinical, biochemical, and immunologic pattern of delayed acute vascular rejection. Transplant Proc 2002; 34:319-20. [PMID: 11959306 DOI: 10.1016/s0041-1345(01)02834-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- P Ramirez
- Liver Transplant Unit, Department of Surgery, University Hospital Virgen Arrixaca, Murcia, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Acosta F, Sansano T, Palenciano CG, Roqués V, Clavel N, González P, Robles R, Bueno FS, Ramirez P, Parrilla P. Relationship between cardiovascular state and degree of hepatic dysfunction in patients treated with liver transplantation. Transplant Proc 2002; 34:266-7. [PMID: 11959277 DOI: 10.1016/s0041-1345(01)02755-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V. Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Acosta F, Sansano T, Palenciano CG, Roqués V, Clavel N, González P, Robles R, Bueno FS, Ramírez P, Parrilla P. Changes in pulmonary circulation during liver transplantation. Transplant Proc 2002; 34:272. [PMID: 11959280 DOI: 10.1016/s0041-1345(01)02758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V.Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Acosta F, Sansano T, Palenciano CG, Roqués V, Clavel N, González P, Robles R, Bueno FS, Ramírez P, Parrilla P. Effects of norepinephrine on right ventricular function during liver transplantation. Transplant Proc 2002; 34:275. [PMID: 11959282 DOI: 10.1016/s0041-1345(01)02760-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V. Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Palenciano CG, Segura B, Ramirez P, Chavez R, Munitiz V, Cayuela MG, Acosta F, Sansano T, Majado M, Muñoz A, Hernandez O, Pino-Chavez G, Loba M, Yelamos J, Gago MR, Vizcaino AS, Asensi H, Marin F, Rubio A, Fuente T, Rios A, Montoya M, Robles R, Bueno FS, Rodriguez JM, Navarro F, Cabezuelo J, Cozzi E, White DJG, Parrilla P. Acid-base and electrolyte disturbances in an experimental model of orthotopic liver xenotransplantation from pig to baboon after graft reperfusion: differences between h-DAF livers and unmodified livers. Transplant Proc 2002; 34:325-6. [PMID: 11959309 DOI: 10.1016/s0041-1345(01)02784-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- C G Palenciano
- Liver Transplant Unit, University Hospital V. Arrixaca, El Palmar, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Fernández J, Robles R, Acosta F, Sansano T, Piñero A, Luján J, Lage A, Parrilla P. Utilidad de la videotoracoscopia en el tratamiento de los derrames pericárdicos. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)71948-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
20
|
Robles R, Parrilla P, Ramírez P, Sánchez F, López J, Marín C, Luján J, Rodríguez J, Fernández J, Sansano T. Bipartición hepática en pacientes con metástasis hepáticas como método de aprendizaje en el trasplante hepático de donante vivo en adultos. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)71916-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
21
|
Acosta F, Sansano T, Palenciano CG, Reche M, Roques V, Beltran R, Robles R, Bueno FS, Ramirez P, Parrilla P. Preoperative pulmonary function in patients treated with liver transplantation. Transplant Proc 2000; 32:2644. [PMID: 11134739 DOI: 10.1016/s0041-1345(00)01819-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Acosta F, Moreno J, Fuente T, Diaz J, Sansano T, Palenciano CG, Reche M, Beltran M, Roques V, Robles R, Bueno FS, Ramirez P, Parrilla P. Influence of surgical technique on the plasma concentration of beta-endorphin during liver transplantation. Transplant Proc 2000; 32:2658. [PMID: 11134748 DOI: 10.1016/s0041-1345(00)01828-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Acosta F, Diaz J, Sansano T, Palenciano CG, Reche M, Beltran R, Roques V, Robles R, Bueno FS, Ramirez P, Parrilla P. Evolution of the plasma concentration of norepinephrine in cirrhotic patients during liver transplantation. Transplant Proc 2000; 32:2659-60. [PMID: 11134749 DOI: 10.1016/s0041-1345(00)01829-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Acosta F, Sansano T, Beltran R, Palenciano CG, Reche M, Roques V, Robles R, Bueno FS, Ramirez P, Parrilla P. Is femoral and radial artery pressure different during reperfusion in liver transplantation? Transplant Proc 2000; 32:2647. [PMID: 11134741 DOI: 10.1016/s0041-1345(00)01821-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Acosta F, Sansano T, Palenciano CG, Reche M, Beltran R, Roques RV, Robles R, Bueno FS, Ramirez P, Parrilla P. Hemodynamic effects of rapid paracentesis on liver transplantation. Transplant Proc 2000; 32:2661. [PMID: 11134750 DOI: 10.1016/s0041-1345(00)01830-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital "V.Arrixaca,", Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- P Ramirez
- Department of Surgery, University Hospital Virgen Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- P Ramirez
- Unidad Trasplante Hepatico, University Hospital Virgen Arrixaca, Murcia, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- A Dalmau
- Department of Anaesthesiology and Surgery, Princeps D'Espanya Hospital, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V. Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
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: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V. Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | |
Collapse
|
46
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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+.
Collapse
Affiliation(s)
- J Diaz
- Liver Transplant Unit, University Hospital "Virgen de la Arrixaca," Murcia, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
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] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
48
|
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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
49
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J Diaz
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
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] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- F Acosta
- Liver Transplant Unit, University Hospital V Arrixaca, Murcia, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|