Assessment of the need for routine intraoperative cell salvage in liver transplantation

Purpose: This study aimed to assess the necessity of routine intraoperative cell salvage in liver transplantations. Methods: A total of 327 liver transplants performed between 2014 and 2016 was included in the analysis. Patient data, including pre-transplant examinations, intraoperative red blood cell transfusions, and procedural information, were collected. Results: The median age of the patients was 54 years old, with 67% (219) being male. The most prevalent ABO blood type was O, accounting for 48% (155) of cases. The leading causes of liver disease were hepatitis C (113 cases, 34.6%) and alcohol-related liver disease (97 cases, 29.7%). Out of the 327 liver transplants, allogeneic red blood cell transfusions were administered in 110 cases (34%) with a median of two units of red blood cells per case. Cell salvage was employed in 237 transplants (73%), and successful blood recovery was achieved in 221 cases (93%). Among the group that recovered more than 200 mL of blood, the median volume of recovered blood was 417 mL, with no transfusion of allogeneic blood required. A total of 90 transplants was performed without utilizing cell salvage, and, among these cases, 19 required blood transfusions, with a median of zero units transfused. Conclusions: This study suggests that routine cell salvage is unnecessary for all liver transplantations. The most suitable indication for its use is in patients presenting with portal vein thrombosis and abnormal creatinine levels.

Atividade anti-inflamatória e antinociceptiva da N-Metil-Trans-4-Hidroxi-L-Prolina isolado das folhas de Sideroxylon obtusifolium

Sideroxylum obtusifolium (Humb. ex. Roem. & Schult) T.B. Penn (Sapotaceae) de ocorrência comum na América do Sul, é conhecida no Nordeste do Brasil como “quixabeira”. Os decoctos da cascado caulee das folhas são utilizados na medicina popular como anti-inflamatório. O presente estudo avaliou in vitroe in vivoas propriedades anti-inflamatórias e antinociceptivas do composto N-metil-trans-4-hidroxi-L-prolina (NMP) isolado das folhas de Sideroxylon obtusifolium. Camundongos Swissmachos (25-30g; n=8-10) foram utilizados nos testes da formalina, contorções abdominais induzidas por ácido acético, capsaicina e Von-Frey. Os efeitos anti-inflamatórios foram investigados através dos testes do edema depata e de peritonite, ambos induzidos por carragenina. Foram investigados possíveis mecanismos de ação da NMP através de bloqueio farmacológico por naloxona, ioimbina e glibenclamida. As patas inflamadas pela carragenina foram coletadaseem seguida encaminhadas para o estudo histológico e ensaio imunohistoquímico para TNF-α, iNOS, COX-2 e NF-kB. Foi verificada a participação de neutrófilos através da dosagem de mieloperoxidade (MPO) e a atividade antioxidante foi testada pelo método de DPPH.Os resultados mostraram redução de 35, 42 e 52% na 1º fase (neurogênica) e de 30, 61 e 78% na 2º fase (inflamatória) do teste de formalina, eem 34, 53 e 72% nas contorções abdominais/20 min, induzidas por ácido acético,nas doses de 25, 50 e 100 mg/kg, respectivamente (P<0,05). A NMP (100 mg/kg) diminuiu a hipernocicepção no teste da capsaicina e de Von-Frey (P<0,05). Houve redução do edema após os tratamentos com a NMP em todos os períodos (P<0,05)...

Sideroxylum obtusifolium(Humb. Ex. Roem. & Schult) T. B. Penn (Sapotaceae) of common occurrence in South America, is known in the Northeast of Brazil as "Quixabeira". The decoctions from the stem bark and leaves are used in folk medicine as anti-inflammatory. The present study evaluated by in vitro and in vivo models the anti-inflammatory and antinociceptive effects of the compound N-methyl-trans-4-hydroxy-L-proline (NMP) isolated from the leaves of Sideroxylon obtusifolium. Male Swiss mice (25-30 g; n = 8-10) were used in the tests of formalin, abdominal contractions induced by aceticacid, capsaicin and von-Frey. Anti-inflammatory effects were investigated using the tests of paw edema and peritonitis, both induced by carrageenan. We investigated possible mechanisms of action of NMP through the pharmacological blockade by naloxone, yohimbine and glibenclamide. Furthermore, the inflamed legs by carrageenan were collected and then sent for histological and immunohistochemical assay for TNF-α, iNOS, COX-2 and NF-kB. The participation of neutrophils was verified by myeloperoxidase dosage (MPO) and the antioxidant activity was tested by the DPPH method. The results showed reductions of 35, 42 and 52% in the 1st phase (neurogenic) and of 30, 61 and 78% in the 2nd phase (inflammatory) of the formalin test, and of 34, 53 and 72% in the writhings /20 min induced by acetic acid at the doses of 25, 50 and 100 mg / kg, respectively (P <0.05). NMP (100 mg / kg) reduced the hyperalgesia in the capsaicin and Von-Frey tests (P <0.05). There was a reduction of edema after treatment with NMP at all periods (P <0.05)...