Prediction of primary graft failure by intraoperative quantification of liver perfusion

Klar, E.; Angelescu, M; Zapletal, C.; Weiss, G.; Kraus, T.; Herfarth, Ch.

doi:10.1016/s0041-1345(00)02515-x

Cited by 8 publications

(10 citation statements)

References 4 publications

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“…Anelescu and colleagues could show that microcirculatory derangements after reperfusion in the kidney correlate with impaired graft function after transplantation (19). The same group demonstrated the importance of microcirculatory events in predicting primary graft failure by intraoperative quantification of liver perfusion (20). It has been demonstrated that pancreatic microcirculation is severely impaired after ischemia and reperfusion (11,21) in rats.…”

Section: Discussionmentioning

confidence: 99%

Brain Death Impairs Pancreatic Microcirculation

Obermaier

Dobschuetz

Keck

et al. 2004

American Journal of Transplantation

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Brain death (BD) influences the quality of donor grafts in transplantation. To evaluate the impact of BD on pancreas grafts, we investigated the influence of BD on the microcirculation and histology of the pancreas in a rat model of explosive BD. A group of Wistar rats (n = = 7), rendered brain dead by inflating an intracranially inserted Fogarty catheter was compared with controls (CO) using intravital epifluorescence-microscopy over 4 h after BD induction; functional capillary density (FCD), leukocyte adherence (AL) in post-capillary venules, histology and pancreatic enzymes were investigated. Four hours after BD, FCD decreased (333 ± 11 vs. baseline 444 cm/cm 2 ± 5 SEM; p < 0.01) and showed lower values than CO (388 ± 9 p < 0.01). In BD, AL was increased (628 cells/mm 2 ± 110 SEM vs. baseline 123 ± 32, and vs. CO 180 ± 33; p < 0.001). BD caused increased histological damage (CO 1.6 scorepoints ± 0.7 SD vs. BD 8.3 ± 7.1; p < 0.05). Amylase was higher in BD (p < 0.05) but did not reach pathological values. We show for the first time that BD causes relevant changes in pancreatic microcirculation, histology and leukocyte endothelial interaction which might have a serious impact on the function of grafts. New strategies for preventing this damage are therefore highly desirable in order to improve the outcome of pancreas transplantation.

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Section: Discussionmentioning

confidence: 99%

Brain Death Impairs Pancreatic Microcirculation

Obermaier

Dobschuetz

Keck

et al. 2004

American Journal of Transplantation

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“…Experimental studies have demonstrated that ASAT levels and bile flow positively correlate with the number of nonperfused sinusoids and the decrease in erythrocyte flux, indicating the dependency of hepatocellular integrity and excretory function on the quality of microvascular perfusion and tissue oxygenation following ischemia 14. While intravital fluorescence microscopy represent the gold standard in experimental microcirculatory research, the estimation of human hepatic microcirculation has been restricted to laser Doppler flowmetry,9 thermodiffusion,7 and hepatic oxygenation 29. By using thermodiffusion, Klar et al7 demonstrated a correlation between hepatic perfusion and clinical parameters with grafts being divided in those with initial good and those with initial non‐function.…”

Section: Discussionmentioning

confidence: 99%

“…Intravital fluorescence microscopy currently represents the standard method for the experimental assessment of microcirculatory impairment; however, intravital fluorescence microscopy cannot be used clinically because of the complex technical setup and the necessity of contrast enhancement by potentially toxic fluorescent dyes. Therefore, numerous non‐imaging techniques have been used clinically, including thermodiffusion7 and laser Doppler flowmetry 8. Both methods demonstrated their value in estimating aspects of liver microcirculation and tissue perfusion under clinical conditions 7, 9.…”

mentioning

confidence: 99%

“…Therefore, numerous non‐imaging techniques have been used clinically, including thermodiffusion7 and laser Doppler flowmetry 8. Both methods demonstrated their value in estimating aspects of liver microcirculation and tissue perfusion under clinical conditions 7, 9. However, these techniques do not permit the direct visualization of the individual segments of the human hepatic sinusoidal network in vivo, and interpretation of the acquired data is a controversial discussion.…”

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confidence: 99%

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Initial hepatic microcirculation correlates with early graft function in human orthotopic liver transplantation

et al. 2005

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Microcirculatory disturbances are an initial causative determinant in hepatic ischemia/reperfusion injury. The aim of this study was to assess sinusoidal perfusion during human liver transplantation using orthogonal polarization spectral imaging and to evaluate the significance of intraoperative microcirculation for early postoperative graft function. Hepatic microcirculation was measured in 27 recipients undergoing full-size liver transplantation and compared to a group of 32 healthy living-related liver donors. The microvascular parameters were correlated with postoperative aspartate aminotransferase and bilirubin levels. Hepatic perfusion following liver transplantation was found to be significantly decreased when compared with the control group.

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“…Intrahepatic hemodynamic alteration of the liver graft in the recipient is associated with graft regeneration [8], graft function recovery [9,10], and patient survival, but it may lead to injury to the graft. The graft size affects graft hemodynamics, as shown in several animal experiments [11,12].…”

Section: Introductionmentioning

confidence: 99%