Intraoperative Blood Flow Measurements in Organ Allografts Can Predict Postoperative Function

Lisik, Wojciech; Gontarczyk, G.; Kosieradzki, Maciej; Łągiewska, B; Pacholczyk, Marek; Adadyński, L; Kobryn, A.; Kwiatkowski, A.; Chmura, A.; Kahan, Barry D.; Rowińskí, W

doi:10.1016/j.transproceed.2007.01.046

Cited by 30 publications

(13 citation statements)

References 6 publications

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“…Moreover, potential confounders within the groups were not considered. In contrast, Lisik et al25 suggested a correlation between portal flow and early liver function. This analysis, however, included only 15 patients, and this may limit its clinical relevance.…”

Section: Discussionmentioning

confidence: 92%

Arterial blood flow predicts graft survival in liver transplant patients

et al. 2011

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Proper liver perfusion is essential for sufficient organ function after liver transplantation. The aim of this study was to determine the effects of portal and arterial blood flow on liver function and organ survival after liver transplantation. The arterial and portal venous blood flow was measured intraoperatively by transit time flow measurement after reperfusion for 290 consecutive liver transplants. The graft survival, hepatic cell damage (alanine aminotransferase and aspartate aminotransferase), and liver function (prothrombin ratio and bilirubin) were determined. Grafts were stratified into groups according to arterial blood flow measurements [<100 mL/minute for arterial blood flow group I (ART I), 100-240 mL/minute for ART II, and 240 mL/minute for ART III] and portal venous blood flow measurements (<1300 mL/minute for portal venous blood flow group I and 1300 mL/minute for portal venous blood flow group II). With multivariate analysis, the impact of blood flow on graft survival was determined, and potential confounders were considered. Decreased portal venous blood flow was associated with significantly less organ survival in univariate analysis but not in multivariate analysis. In contrast, the arterial blood flow was significantly correlated with organ survival after liver transplantation in univariate and multivariate analyses [hazard rate ratio ¼ 2.5, confidence interval ¼ 1.6-4.1, P < 0.001, median survival ¼ 56.6 (ART I), 82.7 (ART II), or 100.7 months (ART III)]. Moreover, low arterial blood flow resulted in impaired postoperative organ function and higher rates of primary nonfunction. Biliary complications were not affected by blood flow. Other risk factors for graft failure that were identified by multivariate analysis included retransplantation, histidine tryptophan ketoglutarate solution versus University of Wisconsin solution, and donor treatment with epinephrine. Impaired arterial blood flow after reperfusion represents a significant predictor of primary graft nonfunction and is associated with impaired graft survival. Whether the intraoperative measurement of hepatic arterial flow is predictive of graft survival should be evaluated in a prospective trial.

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Section: Discussionmentioning

confidence: 92%

Arterial blood flow predicts graft survival in liver transplant patients

et al. 2011

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“…Indeed, no differences in RBF have been found between immediate graft function (or recovering acute renal failure) and delayed graft function (or sustained acute renal failure) in allograft recipients, using Doppler flowmetry [29] or p -aminohippurate and phase contrast cine-magnetic resonance imaging methods [17, 22]. …”

Section: Discussionmentioning

confidence: 99%

Time-intensity curve analysis of contrast-enhanced ultrasound is unable to differentiate renal dysfunction in the early post-transplant period - a prospective study

Araújo

Suassuna

2018

BMC Nephrol

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BackgroundContrast enhanced ultrasonography (CEUS) assessment of kidney allografts mainly focuses on graft rejection. However, studies on delayed graft function (DGF) without acute rejection are still lacking. The aim of this study was to build a time-intensity curve (TIC) using CEUS in non-immunological DGF to understand the utility of CEUS in early transplantation.MethodsTwenty-eight patients in the short-term postoperative period (<14 days) were divided according to the need for dialysis (early graft function [EGF] and [DGF]) and 37 subjects with longer than 90 days follow-up were divided into creatinine tertiles. Time to peak [TTP] and rising time [RT were compared between groups.ResultsEGF and DGF were similar, except for creatinine. In comparison to the late group, medullary TTP and RT were shorter in the early group as well as the delay regarding contrast arrival in the medulla (in relation to cortex) and reaching the medullary peak (in relation to artery and cortex). In the late group, patients with renal dysfunction showed shorter temporal difference to reach medullary peak in relation to artery and cortex.ConclusionsAlthough it was not possible to differentiate EGF and DGF using TIC, differences between early and late groups point to blood shunting in renal dysfunction.

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“…The association of hepatic arterial blood flow with stenosis and thrombosis was appreciated and it was then demonstrated that interventions to improve blood flow could result in improved outcomes 11–13 . More recently, it has been suggested that the portal vein blood flow is the more significant variable in terms of transplant outcome 14 …”

Section: Introductionmentioning

confidence: 99%

“…[11][12][13] More recently, it has been suggested that the portal vein blood flow is the more significant variable in terms of transplant outcome. 14 We were specifically interested in identifying factors that we could improve after the donor and recipient had been identified and the procedure initiated. We suspected that beyond impacting the allograft survival, the vascular inflow would impact patient survival.…”

Section: Introductionmentioning

confidence: 99%