ABSTRACT
Background: Preservation solutions are critical for organ transplantation. In liver transplant (LT), the solution developed by the University Of Wisconsin (UW) is the gold-standard to perfuse deceased brain death donor (DBD) grafts. Histidine-Tryptophan-Ketoglutarate (HTK), formerly a cardioplegic infusion, has been also used in solid organ transplantation. Aim: To compare the outcomes of LT in our center using either HTK or UW solution. Patients and Methods: Retrospective study including 93 LT DBD liver grafts in 89 patients transplanted between March 1994 and July 2010. Forty-eight grafts were preserved with UW and 45 with HTK. Donor and recipient demographics, total infused volume, cold ischemia time, post-reperfusion biopsy, liver function tests, incidence of biliary complications, acute rejection and 12-month graft and patient survival were assessed. Preservation solution costs per liver graft were also recorded. Results: Donor and recipient demographics were similar. When comparing UW and HTK, no differences were observed in cold ischemia time (9.6 ± 3 and 8.7 ± 2 h respectively, p = 0.23), biliary complications, the incidence of acute rejection, primary or delayed graft dysfunction. Histology on post-reperfusion biopsies revealed no differences between groups. The infused volume was significantly higher with HTK than with UW (9 (5-16) and 6 (3-11) l, p < 0.001). The cost per procurement was remarkably lower using HTK. Conclusions: Perfusion of DBD liver grafts with HTK is clinically equivalent to UW, with a significant cost reduction.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Liver , Liver Transplantation/methods , Organ Preservation Solutions , Organ Preservation/instrumentation , Adenosine , Allopurinol , Brain Death , Glucose , Glutathione , Graft Survival/drug effects , Graft Survival/physiology , Insulin , Liver Failure/pathology , Mannitol , Potassium Chloride , Procaine , Raffinose , Retrospective Studies , Tissue DonorsABSTRACT
Acute liver failure has a mortality rate in excess of 80 percent. Most deaths are attributed to brain edema with intracranial hypertension and herniation of structures, where ammonium plays a major role in its generation. We report an 18 year-old female with a fulminant hepatic failure caused by virus A infection. The patient developed a profound sopor and required mechanical ventilation. A CT scan showed the presence of brain edema and intracranial hypertension. A Raudemic® catheter was inserted to measure intracranial pressure and brain temperature. Intracranial hypertension became refractory and intravascular hypothermia was started, reducing brain temperature to 33°C. Seventy two hours later, a liver transplantation was performed. After testing graft perfusion, rewarming was started, completing 122 hours of hypothermia at 33°C. The patient was discharged in good conditions after 69 days of hospitalization.
Subject(s)
Adolescent , Female , Humans , Hyperthermia, Induced/methods , Intracranial Hypertension/therapy , Liver Failure, Acute/complications , Intracranial HypertensionABSTRACT
Background: Orthotopic liver transplantation (OLT) is the treatment of choice for multiple acute and chronic end-stage liver diseases as well as for selected cases of liver malignancy and ¡iver-site metabolic disorders. Neurological impairment is a major source of morbidity and moñality following OLT. Aim: To describe the incidence and the type of neurological complications occurring in the post-operative period of OLT in patients transplanted in our hospital. Material and methods: Between March 1994 and August 2007, 76 adult patients underwent OLT. Data on incidence, time of onset, and outcome of central nervous system (CNS) complications have been obtained from our program data base and patient charts. Results: Twenty three patients (30.3 percent) had CNS complications following OLT. The leading complications were immunosuppressive drug-related neurological impairment in nine patients (39.1 percent), peripheral nerve damage in five patients (21.7 percent), central pontine myelinolysis in four patients (17.4 percent), cerebrovascular disease in three (13 percent) and CNS infection in three (13 percent). Most CNS events (90 percent) occurred in the first 2 weeks after OLT. Five patients with neurological complications died (22 percent). Conclusions: CNS complications occurred in almost one fifth of the population studied, and they had a poor outcome, as previously reported).