RESUMEN
Seventy-two patients who underwent orthotopic liver transplantation (OLT) were studied to identify perioperative variables that would predict survival and intraoperative blood loss. Survival and intraoperative blood loss were not affected by encephalopathy, length of donor liver ischemia, or any of the preoperative laboratory values studied. Survival was significantly decreased in patients requiring postoperative dialysis (41%) and in patients who had severe rejection requiring retransplantation (33%). Intraoperative blood loss was significantly greater in patients over 50 years of age (11.6 blood volumes) and patients with biliary atresia (8.7 blood volumes). These results may aid in choosing future recipients for orthotopic liver transplantation and in anticipating the postoperative support needed.
Asunto(s)
Trasplante de Hígado , Adolescente , Adulto , Factores de Edad , Atresia Biliar/cirugía , Volumen Sanguíneo , Niño , Preescolar , Femenino , Rechazo de Injerto , Hemorragia/etiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Derivación Portocava Quirúrgica/efectos adversos , Complicaciones Posoperatorias , Periodo Posoperatorio , Diálisis Renal , Reoperación , Estudios RetrospectivosAsunto(s)
Atresia Biliar/terapia , Hepatopatías/terapia , Trasplante de Hígado , Derivación Arteriovenosa Quirúrgica/métodos , Atresia Biliar/mortalidad , California , Niño , Preescolar , Femenino , Rechazo de Injerto , Humanos , Inmunosupresores/uso terapéutico , Cuidados Intraoperatorios/métodos , Hepatopatías/mortalidad , Masculino , Complicaciones Posoperatorias/epidemiología , ReoperaciónAsunto(s)
Trasplante de Hígado , Calidad de Vida , Actividades Cotidianas , Adulto , Niño , Femenino , Humanos , Tiempo de Internación , Masculino , Ocupaciones , Aceptación de la Atención de Salud , Complicaciones Posoperatorias , Embarazo , Trasplante Homólogo/psicología , Trasplante Homólogo/rehabilitaciónRESUMEN
PURPOSE: Abdominal aortic aneurysms (AAAs) rupture when the wall stress exceeds the strength of the vascular tissue. Intraluminal thrombus may absorb tension and reduce AAA wall stress. This study was performed to test the hypothesis that intraluminal thrombus can significantly reduce AAA wall stress. METHODS: AAA wall stresses were determined by axisymmetric finite element analysis. Model AAAs had external diameters ranging from 2.0 to 4.0 cm. Model parameters included: AAA length, 6 cm; wall thickness, 1.5 mm; Poisson's ratio, 0.49; Young's modulus, 1.0 MPa; and luminal pressure, 1.6 x 10(5) dyne/cm2. Stresses were calculated for each model without thrombus, and then were recalculated with thrombus filling 10% of the AAA cavity. Calculations were repeated as thrombus size was increased in 10% increments and as thrombus elastic modulus increased from 0.01 MPa to 1.0 MPa. Maximum wall stresses were compared between models that had intraluminal thrombus and the unmodified models. Stress reduction greater than 25% was considered significant. RESULTS: The maximum stress reduction of 51% occurred when thrombus with elastic modulus of 1.0 MPa filled the entire AAA cavity. Stresses were reduced by only 25% as modulus decreased to 0.2 MPa. Similarly, decreasing thrombus size by 70% resulted in stress reduction of only 28%. Large AAAs experienced greater stress reduction than small AAAs (48% vs 11%). CONCLUSION: Intraluminal thrombus can significantly reduce AAA wall stress.