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Objective To evaluate the value of preoperative model for end-stage liver disease combined with serum sodium (MELD-Na) score for the prediction of the incidence of acute kidney injury (AKI) early after liver transplantation. Methods Clinical data of 315 recipients undergoing orthotopic liver transplantation by retrograde inferior vena caval perfusion were retrospectively analyzed. According to preoperative MELD-Na score, all patients were divided into group A (MELD-Na score≤10, n=115), group B (10<MELD-Na score≤20, n=118) and group C (MELD-Na score>20, n=82). Preoperative and intraoperative parameters of the recipients were statistically compared among three groups. Preoperative parameters included serum creatinine (Scr), blood urea nitrogen (BUN), albumin (Alb), total bilirubin (TB), prothrombin time-international normalized ratio (PT-INR), mean arterial pressure (MAP) and serum Na+,etc. Intraoperative parameters included operation time, vena caval occlusion time, hemorrhage volume, quantity of red blood cell infusion, quantity of plasma transfusion and total fluid infusion volume, etc. The incidence and staging of AKI early after liver transplantation in the recipients were statistically compared among three groups. Spearman's rank correlation analysis was performed to analyze the correlation between preoperative MELD-Na score and AKI staging. Results Preoperative BUN, Alb, TB, PT-INR, MAP and Na+ in the recipients significantly differed among three groups (all P<0.05). Intraoperative vena caval occlusion time, hemorrhage volume, quantity of red blood cell infusion and quantity of plasma transfusion significantly differed among three groups (all P<0.05). In 315 recipients undergoing liver transplantation, the incidence of AKI within postoperative 1 week was 64.8% (204/315), and 43% (49/115), 71% (84/118) and 87% (71/82) in group A, B and C. Statistical significance was identified among three groups (all P<0.05). Spearman's rank correlation analysis revealed that preoperative MELD-Na score was positively correlated with AKI staging (r=0.442, P=0.000). Conclusions MELD-Na score not only acts as a parameter evaluating preoperative patients' conditions, but also serves as a pivotal parameter predicting postoperative incidence of AKI.
ABSTRACT
Since 1950s,the idea of liver transplantation (LT) was proposed,the technique of LT had been gradually and widely applied in the field of surgery.The development of LT experienced three stages,including animal experiment,clinical probation and clinical application.It is well known that LT is the only effective therapeutic method for terminal stage of liver diseases.In liver transplantation,the ischemia-reperfusion injury is difficult to avoid,and an important factor causing poor liver function.Meanwhile,hemodynamic volatility and internal environment disorder are important prognostic factors.How to reduce ischemia-reperfusion injury of the transplanted liver and improve intraoperative hemodynamic changes in liver transplantation is a clinical research focus.Recent studies has indicated that orthotopic liver transplantation retrograde perfusion method can effectively reduce the transplanted liver ischemia-reperfusion injury and improve liver function early after transplantation,and thus significantly improve the success rate of liver transplantation and survival.
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Objective To study the effect of retrograde perfusion through the inferior vena cava (IVC) during moderate hypothermic lower body circulatory arrest on malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in the serum, liver and kidney of pigs. Methods Twenty healthy pigs were randomly divided into two groups: group A had moderate hypothermic lower body circulatory arrest for 90 min, group B had moderate hypothermic lower body circulatory arrest and retrograde perfusion through IVC at the same time. SOD activities and MDA contents in the serum, liver and kidney were analyzed before retrograde perfuston(T1), 1 h after circulatory arrest(T2), and 1 h (T3), 3h (T4), and 5 h (T5) after reperfusion. Results There were no significant differences in SOD activities and MDA contents in the serum, liver or kidney between the two groups at T1 (P<0.05). Serum MDA contents were increased and the SOD activities were decreased in both groups at T3, T4, and T5, with the changes in group B being significantly small than those in group A (P<0.05). MDA contents in the liver and kidney in group A were significantly higher and the SOD accivicies were significantly lower than those in group B at T2-T5 (P<0.05). Conclusion Retrograde perfusion with autologous blood through IVC can partly alleviate the ischemic-reperfusion injury of liver and kidney during moderate hypothermic lower body circulatory arrest in pigs, showing a protective effect on the hepatic and renal function.
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Artigo de revisão, numa perpectiva histórica, de trabalho experimental realizado em cães, em 1962, sobre técnica de reperfusão miocárdica retrógrada pelo seio coronariano. Esta técnica pioneira, apresentada neste artigo como um resgate histórico, representa um legado importante pela atual repercussão internacional da sua utilização no tratamento da doença coronariana com células-tronco.
Paper presenting a historical review of an experimental study conducted with dogs in 1962, exploring a retrograde myocardial retroperfusion technique for the coronary sinus. This pioneering approach is presented in this paper in order to preserve this historic feat,constituting an important legacy due to current international repercussions prompted by its use for treating acute myocardial infarction and stem celltreatment of coronary disease.
Subject(s)
Animals , Dogs , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Myocardial Reperfusion/veterinary , Risk FactorsABSTRACT
Since 1998, as a method of operating on descending thoracic aortic disease, especially distal aortic disease, a simple circulatory support technique, which uses the axillary artery or the ascending aorta as the aortic inflow, and the inferior vena cava for total body retrograde perfusion of cold oxygenated blood during circulatory arrest for open proximal anastomosis has been applied. This technique has been used in 25 consecutive cases over 10 years. In this report, we evaluate the efficacy of this support technique. From our experience, an atherosclerotic lesion in the ascending aorta required selection of the femoral artery as an aortic inflow site in 7 patients. Prolonged ventilatory support was unnecessary postoperatively unless neurological sequelae supervened, and no heart or visceral organ complications were occurred recognized. The hospital mortality rate was 16%. These results suggest our technique will continue to play an important role in operations on descending thoracic aortic diseases.
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BACKGROUND: Conventional ascending aortic cross clamping is often limited. This study was carried out to evaluate the safety and efficacy of an endovascular aortic clamping technique with an intraaortic balloon catheter. MATERIAL AND METHOD: From April 2004 to January 2007, surgery with endoaortic clamping was performed in seven patients. A retrograde access perfusion (RAP) catheter was used in six patients and a Pruitt's balloon catheter in two patients. The indication for the operation was a retrosternal pseudoaneurysm of the aortic root in six patients, diffuse calcification of the ascending aorta with aortic regurgitation in 2 patients and an atrial septal defect in one patient. Five patients had at least two prior cardiac surgeries. RESULT: Successful insertion of the catheter and endoaortic clamping was achieved in all patients. CONCLUSION: The endovascular aortic clamping technique with a balloon catheter was a useful alternative method for patients in whom conventional cardiac surgery was limited.