Risk factors for severe ischemic injury after liver transplantation

Bilbao, Itxarone; Charco, Ramón; Hidalgo, Ernest; Lázaro, José; Balsells, J.; Murio, E.; Margarit, C

doi:10.1016/s0041-1345(96)00123-6

Cited by 106 publications

(190 citation statements)

References 6 publications

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“…PDF is associated with longer ICU stays, greater infection rates, and significantly lower 1-and 6-month patient and graft survival rates. 3,4 The recent adoption in clinical practice of a more aggressive approach to organ recruitment has introduced a greater potential risk for postoperative graft dysfunction. Although there is a large body of evidence to show that older donors and fatty livers significantly increase the incidence of PDF, the present donor shortage has encouraged the use of so-called marginal livers and grafts from elderly donors (Ͼ65 years).…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Although it is less frequent than for other organs, such as the kidney, primary graft dysfunction (PDF) after OLT unrelated to any direct surgical, immunologic, or other complications still occurs in a significant number of recipients. [3][4][5][6][7] Grafts with initial poor function (IPF) have a greater than normal graft failure rate in the first 3 months after OLT. 1 One of the causes of PDF is poor organ quality at the time of OLT, which can depend on the condition of the donor, cold ischemia time (CIT), and organ preservation method.…”

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confidence: 99%

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A multicenter pilot prospective study comparing Celsior and University of Wisconsin preserving solutions for use in liver transplantation

Cavallari

Cillo

Nardo

et al. 2003

Liver Transplantation

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Primary dysfunction (PDF) still occurs after orthotopic liver transplantation (OLT). Celsior solution (CS) might offer some advantages over the conventional University of Wisconsin (UW) solution for organ preservation, but to date, this has not been prospectively evaluated in the context of OLT. In this prospective, randomized, multicenter, pilot study, 215 potential liver donors were enrolled and randomized. In 42 cases, the livers were unsuitable for transplantation; therefore, 173 randomized livers ultimately were implanted after perfusion and cold preservation with CS (n ‫؍‬ 83) or UW solution (n ‫؍‬ 90). In accord with the indications of the CS manufacturing company, total CS infusion volume was 90 mL/kg, greater than that of UW solution (60 mL/kg). The main aim of the study is to compare the prevalence of PDF between the two groups. Donor and recipient variables were similar in the two groups. Episodes of PDF were numerically lower in the CS (2.4%) than UW group (7.8%), but the difference was not statistically significant. There was a trend toward a lesser need for early re-OLT (<30 days) in the CS group (P ‫؍‬ .0507), but again, no statistically significant difference emerged. Overall and time-differentiated postoperative deaths also were similar. One-year actuarial patient (UW, 89% v CS, 87%) and graft (UW, 83% v CS, 85%) survival rates were similar. In conclusion, CS was similar to UW solution as a preservation solution in the clinical setting of OLT at the infusion volumes described, although some theoretical advantages of CS composition suggest that CS might prove a valid alternative to UW preservation solution in multiorgan harvesting, including the liver. A study on a larger patient basis is needed. (Liver Transpl 2003;9:814-821.)

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A multicenter pilot prospective study comparing Celsior and University of Wisconsin preserving solutions for use in liver transplantation

Cavallari

Cillo

Nardo

et al. 2003

Liver Transplantation

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“…2 On these grounds, we defined suboptimal livers as those with 1 major negative factor and/or at least 2 minor factors. This definition, based on several studies published in recent years, 2,[6][7][8][9][10][11][16][17][18][19][20] revealed a statistically significant impact on post-LT graft and patient survival rates in a retrospective analysis of our last 400 cases (our unpublished data).…”

Section: Discussionmentioning

confidence: 80%

“…[6][7][8][9][10][11] Grafts with a poor initial function have a higher than normal graft failure rate in the first 3 months after transplantation. 6 The etiology of PDF has yet to be clarified and several factors are thought to be involved-primarily poor organ quality at the time of the transplantation, which may depend on the condition of the donor, the cold ischemia time and/or the organ preservation method.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation using suboptimal grafts: Impact of donor harvesting technique

et al. 2007

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In recent years, an increasing number of suboptimal grafts has been used to reduce the gap between the supply and demand of organs for liver transplantation (LT). In this randomized prospective study, we tested the impact of donor harvesting technique on the posttransplantation outcome of suboptimal donor livers. A modified double perfusion (MDP) technique (aortic and portal cooling with tourniquet clamping of splenomesenteric vein inflow) was compared with the single aortic perfusion (SAP) technique. Between February and November 2005, 35 suboptimal grafts were randomly assigned to either technique (18 MDP livers and 17 SAP livers). Donor and recipient variables were comparable in the 2 study groups. The SAP group had significantly higher blood transaminases and bilirubin levels after LT. The prevalence of graft primary dysfunction (PDF) was also significantly higher (P ϭ 0.01) in the SAP group (35%) than in the MDP group (5%). In 5 cases, all in the SAP group (P ϭ 0.02), early re-LT (Ͻ30 days) was needed. The 6-month patient and graft survival rates were significantly higher in the MDP (100% in both cases) than in the SAP group (68% and 58%, respectively). The study was stopped in November 2005, when the interim analysis revealed such markedly significant differences between the two groups. In conclusion, the present study showed a very low prevalence of PDF, death, and re-LT after transplantation with suboptimal liver when a MDP technique was used to harvest the donor graft.

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“…La incidencia de estas complicaciones en la cohorte analizada en este estudio fue comparable a la observada en otras series (9,15,16). La nefrotoxicidad constituye un efecto secundario muy grave de la medicación inmunosupresora (2).…”

Section: Discussionunclassified

Factores pronósticos de complicaciones postoperatorias en el trasplante hepático

Rodríguez‐Ariza¹,

Monrobel

Martı́nez-Galisteo³

et al. 2008

Rev. esp. enferm. dig.

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INTRODUCCIÓNEl trasplante hepático ortotópico (THO) es el tratamiento de elección para enfermedades hepáticas agudas o crónicas en estadio final. Sin embargo, el seguimiento de Factores pronósticos de complicaciones postoperatorias en el trasplante hepáticoA. Rodríguez-Ariza, A. Monrobel, E. Martínez-Galisteo 1 , C. Alicia Padilla 1 , J. A. Bárcena 1 , E. Fraga, G. Costán, P. Barrera, A. Poyato, J. L. Montero, P. López-Cillero 2 , J. Muntané y M. de la Mata RESUMENObjetivo: la evolución postoperatoria de los pacientes sometidos a trasplante hepático ortotópico (THO) se encuentra frecuentemente asociada a la aparición de diversas complicaciones tales como disfunción renal, rechazo agudo, infecciones y complicaciones neurológicas. Estas complicaciones constituyen las causas más significativas de morbilidad y mortalidad tempranas en pacientes que reciben un THO. El propósito del presente estudio es la identificación de factores relacionados con las distintas complicaciones postoperatorias del THO. Diseño experimental: se llevó a cabo un estudio prospectivo.Pacientes: se analizaron 78 variables en 32 pacientes consecutivos sometidos a THO. Utilizando un análisis de regresión logística se identificaron aquellos factores asociados de forma independiente con la aparición de complicaciones postoperatorias.Resultados: el análisis multivariante demostró que los niveles pretrasplante en suero de malondialdehído y creatinina estaban asociados con el desarrollo de disfunción renal. Los niveles pretrasplante de hemoglobina y las unidades de plaquetas administradas durante la cirugía fueron factores pronósticos de infecciones. El rechazo agudo fue pronosticado por los niveles séricos de γ-glutamil transpeptidasa y de bilirrubina total. Los niveles pretrasplante de sodio y glutaredoxina en suero estuvieron asociados con complicaciones neurológicas.Conclusiones: proponemos estos marcadores para la identificación de pacientes de alto riesgo, permitiendo una vigilancia y/o tratamiento anticipados que mejorarán la morbilidad y la supervivencia en pacientes sometidos a THO. ABSTRACTObjectives: the postoperative evolution of patients submitted to orthotopic liver transplant (OLT) is frequently associated with the appearance of different types of complications such as renal failure, graft rejection, infections, and neurological disorders. These complications are the most significant causes of early morbidity and mortality in patients undergoing OLT. The purpose of the present study was the identification of factors related to the different postoperative complications after OLT. Experimental design: a prospective study was carried out.Patients: seventy-eight variables were analyzed in 32 consecutive patients undergoing OLT. The factors independently associated with the appearance of postoperative complications were identified using a stepwise logistic regression analysis.Results: the multivariate analysis showed that malondialdehyde and creatinine pretransplant serum levels were associated with the development of renal dysfunction. T...

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Risk factors for severe ischemic injury after liver transplantation

Cited by 106 publications

References 6 publications

A multicenter pilot prospective study comparing Celsior and University of Wisconsin preserving solutions for use in liver transplantation

A multicenter pilot prospective study comparing Celsior and University of Wisconsin preserving solutions for use in liver transplantation

Liver transplantation using suboptimal grafts: Impact of donor harvesting technique

Factores pronósticos de complicaciones postoperatorias en el trasplante hepático

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