meld score a reliable outcome predictor in living donor liver transplantation?

In patients undergoing orthotopic liver transplantation [OLT], some studies have shown that a higher preopcrative MELD score is associated with higher morbidity and mortality [Saab et aL 2003]. Other studies also suggest that higher MELD scores are associated with increased inlraoperativc risks [Xia et al 2008]. to evaluate the impact of preoperative MELD status on metabolic, electrolyte and haemodynamic changes during living donar liver transplantation, and consequently on outcome and for right choice of candidate who will get greatest benefit from transplantation. After approval iron- ethical committee and a written consent from every patient a prospective observational study including 40 patients scheduled for living donor liver transplantation in Wady El nile hospital. Patients classified according to MELD score into group 1 [Gl] with score <25 and group2 [G2] > 25. Haemodynamic, metabolic and electrolytes data collected during the three phases: pro anhepatic, anhepatic and post reperfusion phase and follow up for 1[st] post operative week then two years mortality. G2 associated with significant intraoperative haemodynamic disturbances in all stages compared to Gl in the form of lower mean arterial blood pressure, lower systemic vascular resistance, higher pulmonary vascular resistance, and higher cardiac output. Also there were more intraoperative metabolic and electrolyte disturbances as there were more acidosis, lower standard bicarbonate values, more base deficits, more negative anion gap and strong ion difference, higher serum potassium level, poor intraoperative glycemic control and much higher blood lactate level. Also there were higher early mortality in G2 8 cases [40%] while 3 cases [15%] in GL 2 years mortality in Gl 5 cases [25%] while 10 cases [50%] in G2,, time of ICU stay was 5.1 days in G1 and 7 days in G2 time of hospital stay was 21.6 days in Gl and 26.2 days in G2 High MELD score patients associated with more intraoperative haemodynamic, metabolic and electrolyte disturbances, longer postoperative ICU and hospital stay and higher mortality

effect of aminophylline versus milrinone on ischemia-reperfusion myocardial injury during open heart surgery

Cardioplegic arrest during cardiopulmonary bypass [CPB] is essential for the majority of cardiac surgical procedures; Cardioplegia protects the myocardium by providing continuous or intermittent oxygen while simultaneously reducing cardiomyocyte oxygen demand, but it does not inherently increase the ischemic-reperfusion injury tolerance of the cardiomyocytes. Aminophylline and milrinone by their phosphodiesterase inhibitor and anti-inflammatory activity may decrease this type of injury. This study has been designed to compare between the protective effect of aminophylline and milrinone over the heart during open heart surgery for valve replacement with CPB. Sixty adult patients undergoing elective single valve replacement were randomized to receive aminophylline 5 mg/kg [n=20], milrinone 50 microg/kg [n=20], or normal saline as control group [n=20] through intravenous infusion 10 minutes before the aortic cross-clamping. The cardiac troponin I, inotrope score, duration of mechanical ventilation, and length of ICU stay and other hemodynamic variables were measured and recorded. There were no differences between the three groups with regard to clinical variables. Cardiac troponin I raised significantly after declamping in the three groups, however it was significantly lower in aminophylline and milrinone group compared to control group immediately after CPB and after 8 hours with no significant differences between aminophylline and milrinone group, inotrope score duration of mechanical ventilation and length of ICU stay showed no significant differences between the three groups. Administration of aminophylline or milrinone reduces the subclinical myocardial injury with no difference between both agents and with no effect on the hemodynamic parameters or short term clinical outcome in patients undergoing single valve replacement with CPB