RESUMEN
INTRODUCTION: Hypothermic machine perfusion (HMP) is increasingly investigated as a means to assess liver quality, but data on viability markers is inconsistent and the effects of different perfusion routes and oxygenation on perfusion biomarkers are unclear. METHODS: This is a single-centre, randomised, multi-arm, parallel study using discarded human livers for evaluation of HMP using arterial, oxygen-supplemented venous and non-oxygen-supplemented venous perfusion. The study included 2 stages: in the first stage, 25 livers were randomised into static cold storage (n = 7), hepatic artery HMP (n = 10), and non-oxygen-supplemented portal vein HMP (n = 8). In the second stage, 20 livers were randomised into oxygen-supplemented and non-oxygen-supplemented portal vein HMP (n = 11 and 9, respectively). Changes in dynamic, biochemical, and morphologic parameters during 4-hour preservation were compared between perfusion groups, and between potentially transplantable and non-transplantable livers. RESULTS: During arterial perfusion, resistance was higher and flow was lower than venous perfusion (p = 0.001 and 0.01, respectively); this was associated with higher perfusate markers during arterial perfusion (p>0.05). Supplementary oxygen did not cause a significant alteration in the studied parameters. Morphology was similar between static and dynamic preservation groups. Perfusate markers were 2 fold higher in non-transplantable livers (p>0.05). CONCLUSIONS: Arterial only perfusion might not be adequate for graft perfusion. Hepatocellular injury markers are accessible and easy to perform and could offer insight into graft quality, but large randomised trials are needed to identify reliable quality assessment biomarkers.
Asunto(s)
Hipotermia Inducida/métodos , Hígado , Preservación de Órganos/métodos , Perfusión/métodos , Adulto , Anciano , Selección de Donante , Arteria Hepática , Humanos , Hipotermia Inducida/instrumentación , Técnicas In Vitro , Hígado/anatomía & histología , Hígado/fisiología , Trasplante de Hígado , Persona de Mediana Edad , Preservación de Órganos/instrumentación , Oxígeno/administración & dosificación , Perfusión/instrumentación , Vena Porta , Donantes de TejidosAsunto(s)
Aneurisma de la Aorta , Disección Aórtica/complicaciones , Rotura de la Aorta/complicaciones , Atrios Cardíacos/fisiopatología , Anciano , Disección Aórtica/cirugía , Rotura de la Aorta/cirugía , Ecocardiografía , Atrios Cardíacos/diagnóstico por imagen , Humanos , Masculino , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Variación Anatómica , Axila/anomalías , Mastectomía/métodos , Músculo Esquelético/anomalías , Biopsia del Ganglio Linfático Centinela/métodos , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Metástasis Linfática/diagnóstico , Metástasis Linfática/patología , Ganglio Linfático Centinela/patologíaRESUMEN
We present the case of a 27-year-old man who underwent percutaneous atrial septal defect (ASD) repair using the Amplatzer(®) (St Jude Medical, St Paul, MN, US) septal occluder (ASO). Six weeks later, he presented with heart failure and was found to have an aorto-right atrial fistulation. He required urgent surgical device explantation and repair of the existing ASD using a pericardial patch repair technique. This is the first case to be reported from the UK describing a delayed aorto-right atrial fistula following percutaneous closure using ASO.