Transplantation proceedings
-
Randomized Controlled Trial
Propofol attenuates ischemic reperfusion-induced formation of lipid peroxides in liver transplant recipients.
Ischemic reperfusion (IR) injury is known to have an important influence on the success of transplant surgery and the occurrence of complications. Malondialdehyde (MDA) is an intermediate metabolite of lipid peroxidation resulting from IR-induced reactive oxygen species. This study was designed to investigate the protective effects of propofol on IR injury in liver transplant recipients. ⋯ There were significantly higher MDA levels among the control versus the propofol group at 3, 5, 30, and 60 minutes after reperfusion in liver transplant recipients.
-
The aim of this study was to evaluate the impact of macrovesicular (MaS) and microvesicular steatosis (MiS) on postoperative liver function in living donors undergoing right hepatectomy. ⋯ Our results suggested that a mild degree of either MaS or MiS was associated with higher postoperative peak AST and ALT values. A regression analysis showed both MaS and MiS to display similar impacts on postoperative liver functions after living donor right hepatectomy.
-
Comparative Study
Cardiac output derived from arterial pressure waveform analysis in patients undergoing liver transplantation: validity of a third-generation device.
Hemodynamic monitoring is essential to a successful liver transplantation procedure. FloTrac, a hemodynamic monitor that uses arterial-waveform-based pulse contour analysis for cardiac output (CO) measurement, has proven useful in many clinical settings. One of the primary foci of FloTrac's recent third-generation software upgrade was improving its accuracy in low systemic vascular resistance status. We evaluated the accuracy of the upgraded FloTrac monitor during liver transplantation. ⋯ Despite a software upgrade, the effectiveness of the FloTrac artery-derived cardiac output monitor for CO measurement during liver transplantation remains limited.
-
Patients with hepatocellular carcinoma (HCC) exceeding the University of California, San Francisco (UCSF) criteria are normally rejected for cadaveric liver transplants. However, whether they should be allowed to undergo living donor liver transplantation (LDLT) has been controversial. We reviewed the outcome of patients with advanced HCC who underwent LDLT at our center. ⋯ In HCC patients exceeding UCSF criteria, a reasonable 5-year overall survival of 55% post-LDLT can be obtained. Patients with HCC exceeding the UCSF criteria, especially in the older age group with no portal vein invasion and lower AFP level, should be actively considered for LDLT.
-
Comparative Study
Stroke volume variation derived by arterial pulse contour analysis is a good indicator for preload estimation during liver transplantation.
Accurate determination of preload during liver transplantation is essential. Continuous right ventricular end diastolic volume index (RVEDVI) has been shown to be a better preload indicator during liver transplantation than the filling pressures. However, recent evidence has shown that dynamic variables, in this case stroke volume variation (SVV), are also good indicators of preload responsiveness. In this study, we evaluated the correlation between SVV, which we derived from arterial pulse contour analysis and RVEDVI. ⋯ We conclude that SVV is a good indicator for preload estimation during liver transplantation. A higher SVV value is associated with a more hypovolemic fluid status.