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1.
Transplant Proc ; 51(1): 50-55, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30655145

RESUMO

BACKGROUND: The increase in indications for liver transplantation has led to acceptance of donors with expanded criteria. The donor risk index (DRI) was validated with the aim of being a predictive model of graft survival based on donor characteristics. Intraoperative arterial hepatic flow and indocyanine green clearance (plasma clearance rate of indocyanine green [ICG-PDR]) are easily measurable variables in the intraoperative period that may be influenced by graft quality. Our aim was to analyze the influence of DRI on intraoperative liver hemodynamic alterations and on intraoperative dynamic liver function testing (ICG-PDR). METHODS: This investigation was an observational study of a single-center cohort (n = 228) with prospective data collection and retrospective data analysis. Measurement of intraoperative flow was made with a VeriQ flowmeter based on measurement of transit time (MFTT). The ICG-PDR was obtained from all patients with a LiMON monitor (Pulsion Medical Systems AG, Munich, Germany). DRI was calculated using a previously validated formula. Normally distributed variables were compared using Student's t test. Otherwise, the Mann-Whitney U test or Kruskal-Wallis test was applied, depending on whether there were 2 or more comparable groups. The qualitative variables and risk measurements were analyzed using the chi-square test. P < .05 was considered statistically significant. RESULTS: DRI score (mean ± SD) was 1.58 ± 0.31. The group with DRI >1.7 (poor quality) had an intraoperative arterial flow of 234.2 ± 121.35 mL/min compared with the group having DRI < 1.7 (high quality), with an intraoperative arterial flow of 287.24 ± 156.84 mL/min (P = .02). The group with DRI >1.70 had an ICG-PDR of 14.75 ± 6.52%/min at 60 minutes after reperfusion compared to the group with DRI <1.70, with an ICG-PDR of 16.68 ± 6.47%/min at 60 minutes after reperfusion (P = .09). CONCLUSION: Poor quality grafts have greater susceptibility to ischemia-reperfusion damage. Decreased intraoperative hepatic arterial flow may represent an increase in intrahepatic resistance early in the intraoperative period.


Assuntos
Testes de Função Hepática/métodos , Transplante de Fígado , Fígado/irrigação sanguínea , Doadores de Tecidos/provisão & distribuição , Idoso , Estudos de Coortes , Corantes/metabolismo , Feminino , Alemanha , Sobrevivência de Enxerto , Hemodinâmica , Artéria Hepática , Humanos , Verde de Indocianina/metabolismo , Fígado/metabolismo , Masculino , Pessoa de Meia-Idade , Fatores de Risco
2.
Br J Anaesth ; 121(6): 1212-1214, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30442246

RESUMO

Blood troponins are used to diagnose perioperative myocardial injury and infarction. During liver transplantation, a passive donor-recipient troponin transfer with the graft may result in an increase of troponins in the transplant recipient questioning the diagnosis of myocardial injury. We present a case of liver transplantation with sudden elevation of recipient's serum troponin levels immediately after graft reperfusion and its subsequent normalization in which myocardial damage and other non-ischaemic potential causes were ruled out. Patient consent for publication was obtained prior to submission of the manuscript.


Assuntos
Transplante de Fígado/métodos , Troponina/administração & dosagem , Adulto , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Doadores de Tecidos , Troponina T/sangue
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