Liver Regeneration Induced By Extracorporeal Portal Vein Arterialization in a Swine Model of Carbon Tetrachloride Intoxication.

INTRODUCTION: This study aimed to determine whether a controlled portal blood arterialization by a liver extracorporeal device (L.E.O2 NARDO) is effective in treating acute hepatic failure (AHF) induced in swine by carbon tetrachloride (CCl4) administration. MATERIALS AND METHODS: Sixteen swine with AHF induced by intraperitoneal injection of CCl4 in oil solution were randomly divided into 2 groups: animals that received L.E.O2 NARDO treatment 48 hours after the intoxication (study group; n = 8); and animals that were sham operated 48 hours after the intoxication (control group; n = 8). Blood was withdrawn from the iliac artery and reversed in the portal venous system by an interposed extracorporeal device. Each treatment lasted 6 hours. The survival was assessed at 5 days after L.E.O2 NARDO treatment or sham operation. In both groups blood samples were collected for biochemical analysis at different study time and liver biopsies were performed 48 hours after intoxication and at humane killing. RESULTS: In the study group decreased transaminases levels and a more rapid international normalized ratio (INR) recover were detected as compared with the control group. Six animals of the study group (75%) versus 1 animal (12.5%) of the control group survived at 5 days after surgery with a statistically significant difference (P < .05). Liver biopsies performed at humane killing showed damaged areas of the livers reduced in the study group compared with biopsies of the control group. CONCLUSIONS: Arterial blood supply in the portal system through the L.E.O2 NARDO device is easily applicable, efficacious, and safe in a swine model of AHF induced by CCl4 intoxication.

Complications and graft survival in kidney transplants with vascular variants: our experience and literature review.

INTRODUCTION: In the literature several reconstructive techniques for vascular anastomoses in case of kidney graft vascular variants are reported. This article reports our experience in kidney transplants with vascular anomalies. MATERIALS AND METHODS: Between January 1996 and June 2012, 154 cadaveric kidney transplantations were performed at our center. In 35 case, vascular variants were found. Among the arterial variants we observed 27 double arteries, 2 cases with 3 arteries, and 1 case with 4 arteries. All cases of Venous variants were double veins. Based on the type of reconstructive technique used, we divided transplants into group A (n = 22) separate multiple arterial anastomoses; group B (n = 8) anastomosis on the aortic patch; group C (n = 4) single anastomosis in case of 2 arteries with a common ostium at the aortic origin. The venous variants were treated with ligation of the vein of smaller caliber. RESULTS: Kidney preparation to the back table lasted on average 50 minutes with no significant differences between the 3 groups and no significant timing increase compared to renal transplants without vascular anomalies (mean warm ischemia 40 minutes, range 30-60 minutes). The mean cold ischemia time was limited to 16 hours from the removal and the mean warm ischemia was 50 minutes (range 30-70 minutes). There were no differences in timing between group C and single anastomoses, whereas groups A and B showed mean warm ischemia time was slightly increased compared to group C (P < .05). There were no significant differences in terms of delayed upturn of graft function and graft survival between groups A, B, and C and compared to transplants without vascular anomalies. CONCLUSIONS: In our series we observed similar results performing the reimplantation on aortic patch and separate multiple arterial anastomoses. Considering our experience, we believe that vascular variants are not an indication to exclude a graft for transplantation.

Urologic complications in kidney transplantation: a single-center experience.

INTRODUCTION: Urologic complications are an important cause of morbidity in kidney transplantation. To prevent this occurrence, several studies have reported the benefit of stenting. The aim of this study was to compare the efficacy of two different types of stents to protect the urinary anastomosis in kidney transplantation. METHODS: We performed a retrospective analysis of 139 kidney transplant recipients who underwent ureteralneocystostomy by the Lich-Gregoire technique between January 1995 and July 2010. On the basis of the type of stent we divided transplant patients into two groups: group A (n=90), the internal-external Bracci catheter and group B (n=49), the double-J stent. The urologic complications evaluated in both groups were: urinary tract leakage, obstruction, and infections. We also recorded the duration of the postoperative hospitalization. RESULTS: The incidences of urinary fistulae and ureteral strictures between the two groups were similar (around 3%). A higher incidence of urinary infections, however, was registered among group A compared with group B (46% vs 10%; P<.05). The postoperative hospitalization period was consequently longer in group A then group B (35 ± 3 vs 24 ± 2 days; P<.05). CONCLUSION: In our series of kidney transplantations, the occurrence of urinary fistulae and ureteral strictures was not influenced by the type of stent. The use of a double-J stent, however, appeared to be associated with a significantly decreased incidence of urinary tract infections leading to shorter postoperative hospitalizations.

Extracorporeal portal vein arterialization in man after extended hepatectomy to prevent acute liver failure: a case report.

Experimental studies have shown that increasing the oxygen supply to the liver through portal vein arterialization (PVA) enhances liver regeneration after partial hepatectomy. Moreover, our previous study demonstrated a beneficial effect of an extracorporeal device to increase the oxygenated blood to the liver and to improve the survival rate of animals subjected to subtotal hepatectomy. Herein we have reported a case of PVA through an extracorporeal device to treat a man after extended hepatectomy leading to acute liver failure (ALF). An obese 69-year-old man (body mass index > 35) affected by multiple metastases from colorectal cancer underwent 80% liver resection; at laparotomy, a steatotic liver was evident due to adjuvant chemotherapy. Moreover, the liver experienced 20 minutes of hepatic ischemia during the resection. At the end of resection he underwent extracorporeal PVA treatment. Blood was withdrawn from the femoral artery and returned into the portal venous system through the umbilical vein. An extracorporeal device was interposed between the outflow and inflow to monitor hemodynamic parameters. Starting from operating room each of six treatments lasted 6 hours per day. Serum and liver samples were collected daily. The extracorporeal device was dismounted at the seventh postoperative day. The postoperative course was assessed at 1 month. The PVA-extracorporeal treatment yielded beneficial effects for subtotal hepatectomy by decreasing serum ammonia, transaminases, and total bilirubin concentration. The international normalized ratio recovered rapidly, remaining significantly lower during the entire postoperative period. The ten-day postoperative period was uneventful. The patient was discharged in good health. He is alive and well at the moment. The arterial blood supply in the portal system through the umbilical vein using an extracorporeal device was easily applicable, efficacious, safe, and cost-effective. It may represent a novel approach to treat patients with potential ALF after subtotal liver resection.

Kidney transplantation at Annunziata Hospital of Cosenza: report of 10 years experience.

OBJECTIVE: Kidney transplantation represents the gold standard for treatment of patients with end-stage renal disease. Herein we sought to report our 10-year experience with cadaveric kidney transplantations. PATIENTS AND METHODS: From February 1995 to September 2008, we performed 115 kidney transplantations. Patients were followed for an average of 4.9 years (range, 2.2-10.6 years). The cold ischemia time (CIT) averaged 13 +/- 3 hours, while the mean warm ischemic time was 25 +/- 10 minutes. The ureteral-bladder anastomosis was performed using Bracci catheters in the first series of 72 transplants, and double-J stents in the other 41 cases. The average waiting time was 122 +/- 21 months. The immunological regimens were prescribed according to the American Society of Nephrology (K/DOQI) with reference to comorbidity and concomitant risk factors and reported drug toxicity events. We transplanted kidneys with anatomic variations, ie, multiple arteries and double veins, and one double transplant of marginal organs. RESULTS: Our overall complication rate was 9.18%. The 10-year patient and graft survival rates were 89% and 84%, respectively. The percentage of biopsy-proven acute rejection episodes was 22.16%, while chronic allograft nephropathy (CAN) accounted for 15.3% at 5 years. The incidence of delayed graft function (DGF) was 14.05%. Finally, we noted 3 cases of cardiovascular death. CONCLUSION: Our experience showed excellent patient outcomes compared with other Italian and European data.