Hypotension after Reperfusion in Liver Transplantation: Histidine-Tryptophan-Ketoglutarate versus University of Wisconsin Solution

Ghafaripour, S.; Sahmeddini, Mohammad Ali; Lahsaee, S. M.; Khosravi, Mohammad Bagher; Sattari, Hossein; Nikeghbalian, Saman; Shokrizadeh, S.; Malekhosseine, S. A.

doi:10.1177/152692481002000309

Cited by 7 publications

(5 citation statements)

References 28 publications

(47 reference statements)

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“…In surgery, the speed and quality of graft reperfusion are independent predictors of PRS . The incidence of hypotension after reperfusion is greater if histidine tryptophan ketoglutarate solution rather than University of Wisconsin solution is used …”

Section: Discussionmentioning

confidence: 99%

Cardiac arrest during adult liver transplantation: A single institution's experience with 1238 deceased donor transplants

et al. 2013

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Liver transplantation (LT) is one of the highest risk noncardiac surgeries. We reviewed the incidence, etiologies, and outcomes of intraoperative cardiac arrest (ICA) during LT. Adult cadaveric LT recipients from January 1, 2001 through December 31, 2009 were reviewed. ICA was defined as an event requiring either closed chest compression or open cardiac massage. Cardiac arrest patients who recovered with only pharmacological interventions were excluded. Data included etiologies and outcomes of ICA, intraoperative deaths (IDs) and hospital deaths (HDs), and potential ICA risk factors. ICA occurred in 68 of 1238 LT recipients (5.5%). It occurred most frequently during the neohepatic phase (60 cases or 90%), and 39 of these cases (65.0%) experienced ICA within 5 minutes after graft reperfusion. The causes of ICA included postreperfusion syndrome (PRS; 26 cases or 38.2%) and pulmonary thromboembolism (PTE; 24 cases or 35.3%). A higher Model for End-Stage Liver Disease (MELD) score was found to be the most significant risk factor for ICA. The ID rate after ICA was 29.4% (20 cases), and the HD rate was 50.0% (34 cases). The 30-day patient survival rate after ICA was 55.9%, and the 1-year survival rate was 45.6%: these rates were significantly lower (P < 0.001) than those for non-ICA patients (97.4% and 85.1%, respectively). In conclusion, the incidence of ICA in adult cadaveric LT was 5.5% with an intraoperative mortality rate of 29.4%. ICA most frequently occurred within 5 minutes after reperfusion and resulted mainly from PRS and PTE. A higher MELD score was identified as a risk factor.

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Section: Discussionmentioning

confidence: 99%

Cardiac arrest during adult liver transplantation: A single institution's experience with 1238 deceased donor transplants

et al. 2013

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“…Ghafaripour et al . found a significantly lower mean total ischemia time (5.8 and 6.3 vs. 9.5 h) for their flushed and nonflushed HTK group compared to UW preserved grafts. An explanation for this finding has not been given by the authors.…”

Section: Discussionmentioning

confidence: 90%

“…In the first category, laboratory parameters were tested, in which case transaminases and bilirubin were usually used to determine differences in graft damage and function . According to the potential benefit of various graft rinse protocols in preventing PRS, hemodynamic parameters were classified as the second common category , and the third category focused on graft function and survival data . Given the rather low evidence levels and the absence of appropriately designed RCT on the topic, the findings of the literature review failed to indicate which graft rinse protocol provides the best graft quality.…”

Section: Discussionmentioning

confidence: 99%

“…Their measurements in eleven patients revealed that portal vein flush with 500 milliliters of 5% albumin solution washed out more than 90% of the potassium load in the graft. A study published by Ghafaripour in 2010 evaluated the incidence of postreperfusion syndrome after cold storage with HTK versus UW solution, whereas half of the grafts in the HTK group were flushed before reperfusion . The authors concluded that flushing the graft can improve the outcome if cold storage with HTK is applied.…”

Section: Discussionmentioning

confidence: 99%

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Graft rinse prior to reperfusion in liver transplantation: literature review and online survey within the Eurotransplant community

et al. 2015

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SummaryGraft rinse prior reperfusion in liver transplantation (LT) is believed to reduce the incidence of postreperfusion syndrome and improve clinical outcome. A MEDLINE search was performed to obtain a comprehensive review of the published literature dealing with graft rinse in LT. Moreover, all thirty-four LT centers in the Eurotransplant (ET) region were invited to participate in an online survey to whether or not graft rinse is performed and whether further research in the field is needed. Seventeen reports have been found to investigate graft rinse protocols in 1894 LT recipients. Eighteen of the thirty centers that participated in the online survey performed graft rinse prior reperfusion in LT. The most commonly used rinse solution was albumin. Nineteen centers stated interest in participating in a multicenter RCT in the field. The published literature does not provide concluding appraisal of the benefit of graft rinse in LT. Graft rinse protocols are not standardized and are based on personal experience. Appropriately designed clinical trials addressing the topic are demanded. The online survey appears to be a helpful tool for the evaluation of clinical practice and future research topics in the transplant community.

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“…Reperfusion of the liver graft is the most crucial event during LT, which can cause liver graft failure owing to the reperfusion injury (15, 16). Reperfusion injury induces the onset of the mitochondrial permeability transition and mitochondrial uncoupling, which activates the mitochondrial adenosine triphosphatase, and thus leading to adenosine triphosphate depletion which resulted in primary non‐function of the transplanted liver graft (17).…”

Section: Discussionmentioning

confidence: 99%

Glycemic management in living donor liver transplantation for patients with glycogen storage disease type 1b

Karaki¹,

Kasahara²,

Sakamoto³

et al. 2012

Pediatric Transplantation

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GSD type 1b is an autosomal recessive inborn error of carbohydrate metabolism caused by defects of the G6Pase translocase (G6PT). Patients with GSD1b have severe hypoglycemia with several clinical manifestations of hepatomegaly, obesity, a doll-like face, and neutropenia. LT has been indicated for severe glucose intolerance. This study retrospectively reviewed glycemic management of eight children with a diagnosis of GSD1b who underwent liver transplantation (LDLT). Between November 2005 and September 2011, 172 children underwent LDLT, of which eight (4.7%) were indicated for GSD1b. Glucose-rich solution was placed in all children when preoperative fasting started to prevent preoperative hypoglycemia. During the reperfusion of graft, the glucose administration could significantly be reduced to maintain the proper blood glucose level, while the dosage of glucose administration prior to reperfusion of graft was significantly higher in the patients with GSD1b in comparison with patients with BA. The current series also showed significantly high incidence of infectious complications in the patients with GSD1b owing to persistent neutropenia after LDLT. All patients are doing well with an excellent quality of life owing to the stabilization of glucose intolerance. This current study clearly documented drastic change in glycemic management in LDLT. Cautious perioperative management to prevent hypoglycemia and infection is crucial for successful LT.

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Hypotension after Reperfusion in Liver Transplantation: Histidine-Tryptophan-Ketoglutarate versus University of Wisconsin Solution

Abstract: The incidence of hypotension after reperfusion is greater if HTK solution rather than UW solution is used. Flushing of grafted livers preserved with HTK solution might eliminate some vasoactive substances found in HTK solution.

Cited by 7 publications

References 28 publications

Cardiac arrest during adult liver transplantation: A single institution's experience with 1238 deceased donor transplants

Cardiac arrest during adult liver transplantation: A single institution's experience with 1238 deceased donor transplants

Graft rinse prior to reperfusion in liver transplantation: literature review and online survey within the Eurotransplant community

Glycemic management in living donor liver transplantation for patients with glycogen storage disease type 1b

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