Differentiated Therapy with Prostaglandin E1 (Alprostadil) after Orthotopic Liver Transplantation: the Usefulness of Procalcitonin (PCT) and Hepatic Artery Resistive Index (RI) for the Evaluation of Early Graft Function and Clinical Course

Kornberg, Arno; Grube, Thomas; Wagner, Thomas; Voigt, Rico; Homman, Merten; Homann, Merten; Schotte, U.; Schmidt, K.; Scheele, J.

doi:10.1515/cclm.2000.182

Cited by 22 publications

(13 citation statements)

References 22 publications

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“…The mechanism of the transient increase in PCT immediately after LT remains unclear. Some investigators have suggested that PCT synthesis in the graft liver transiently increases just after LT, direct endotoxin influx into the systemic circulation from the small intestine and colon increases during the anhepatic phase, and that transient impairment of endotoxin clearance in the graft liver would be involved . In the present study, serum PCT levels until POD 7 in patients who underwent DDLT were significantly higher than in those who underwent LDLT, although the number of DDLT was small ( n = 14).…”

Section: Discussioncontrasting

confidence: 49%

Perioperative changes of procalcitonin levels in patients undergoing liver transplantation

Kaido

Ogawa

Fujimoto

et al. 2014

Transplant Infectious Dis

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Section: Discussioncontrasting

confidence: 49%

Perioperative changes of procalcitonin levels in patients undergoing liver transplantation

Kaido

Ogawa

Fujimoto

et al. 2014

Transplant Infectious Dis

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“…Treatment with PGE 1 showed beneficial effects in reducing myocardial or hepatocellular I/R injury in patients during cardiac surgery (27) or after orthotopic liver transplantation (46, 32).…”

Section: Clinical Evidence Of I/r Injury and Treatment Applicationsmentioning

confidence: 99%

Ischaemia/Reperfusion Injury of Skeletal Muscle: Mechanisms, Morphology, Treatment Strategies, and Clinical Applications

et al. 2002

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Summary: Background: Any surgical manoeuvre that involves cessation of blood supply to an organ with subsequent re‐establishment of blood flow can result in ischaemia/reperfusion (I/R) injury. The consequences of such injury are local and remote tissue destruction.  Methods: I/R is characterized by ‘no reflow phenomenon’ and interstitial oedema formation. Changes in the production of nitric oxide (NO) and superoxide play an important role in the development of I/R. Overproduction of reactive oxygen‐derived free radicals (OFR) leads to a consumption and depletion of endogenous scavenging antioxidants.  Results: Direct NO measurements showed a production of large concentrations of NO from cNOS at the beginning of ischaemia. Intracellular influx of Ca2+ after onset of ischaemia activates cNOS, leading to local depletion of L‐arginine and subsequently to disarrangement of cNOS, which produces superoxide instead of NO. Microvascular constriction during ‘no reflow’ reflects deficiency in vasodilator NO due to its consumption by vasoconstrictor oxygen free radicals. Stimulated production of thromboxane A2 and endothelin release may also promote ‘no reflow’.  Conclusions: At least two major strategies are viable for preventing I/R injury: (a) treatment with L‐arginine and their analogues, or BH4, thus preventing L‐arginine and H4B deficient conditions, so that cNOS will not produce excessive O2–; (b) scavenging O2– already produced by cNOS and other potential sources of O2– by using large concentrations of free radical scavengers. Further research on oxidant/antioxidant biochemistry and its clinical application is needed.

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“…The aim of this study was to assess preoperative NLR as a prognostic tool of graft function following LDLT. Specifically, we investigated whether NLR could predict EAD following LDLT and compared it with other inflammation‐based indices such as C‐reactive protein (CRP), procalcitonin, lymphocyte‐to‐monocyte ratio (LMR), absolute lymphocyte count, platelet‐to‐lymphocyte ratio (PLR) and the Glasgow prognostic score (GPS). We further evaluated the association between NLR and 1‐year graft failure and 1‐year mortality following LDLT and described the dynamic changes of NLR during the perioperative LDLT period.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil‐to‐lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation

Kwon

Moon

Jung

et al. 2019

Liver International

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Background & Aims:Early allograft dysfunction (EAD) is predictive of poor graft and patient survival following living donor liver transplantation (LDLT). Considering the impact of the inflammatory response on graft injury extent following LDLT, we investigated the association between neutrophil-to-lymphocyte ratio (NLR) and EAD, 1year graft failure, and mortality following LDLT, and compared it to C-reactive protein (CRP), procalcitonin, platelet-to-lymphocyte ratio and the Glasgow prognostic score. Methods:A total of 1960 consecutive adult LDLT recipients (1531/429 as development/validation cohort) were retrospectively evaluated. Cut-offs were derived using the area under the receiver operating characteristic curve (AUROC), and multivariable regression and Cox proportional hazard analyses were performed.Results: The risk of EAD increased proportionally with increasing NLR, and the NLR AUROC was 0.73, similar to CRP and procalcitonin and higher than the rest. NLR ≥ 2.85 (best cut-off) showed a significantly higher EAD occurrence (20.5% vs 5.8%, P < 0.001), higher 1-year graft failure (8.2% vs 4.9%, log-rank P = 0.009) and higher 1-year mortality (7% vs 4.5%, log-rank P = 0.039). NLR ≥ 2.85 was an independent predictor of EAD (odds ratio, 1.89 [1.26-2.84], P = 0.002) after multivariable adjustment, whereas CRP and procalcitonin were not. Increasing NLR was independently associated with higher 1-year graft failure and mortality (both P < 0.001).Consistent results in the validation cohort strengthened the prognostic value of NLR. Conclusions:Preoperative NLR ≥ 2.85 predicted higher risk of EAD, 1-year graft failure and 1-year mortality following LDLT, and NLR was superior to other parameters, suggesting that preoperative NLR may be a practical index for predicting graft function following LDLT. K E Y W O R D S early allograft dysfunction, inflammatory status, living donor liver transplantation, neutrophilto-lymphocyte ratio S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Kwon H-M, Moon Y-J, Jung K-W, et al.Neutrophil-to-lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation. Liver

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Differentiated Therapy with Prostaglandin E1 (Alprostadil) after Orthotopic Liver Transplantation: the Usefulness of Procalcitonin (PCT) and Hepatic Artery Resistive Index (RI) for the Evaluation of Early Graft Function and Clinical Course

Cited by 22 publications

References 22 publications

Perioperative changes of procalcitonin levels in patients undergoing liver transplantation

Perioperative changes of procalcitonin levels in patients undergoing liver transplantation

Ischaemia/Reperfusion Injury of Skeletal Muscle: Mechanisms, Morphology, Treatment Strategies, and Clinical Applications

Neutrophil‐to‐lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation

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