Transfusional optimization in liver transplant using viscoelastic test guided therapy. / Optimización transfusional en el trasplante de hígado usando terapia guiada por pruebas viscoelásticas.

BACKGROUND: Assess the reduction of packed red blood cells (PRBCs) transfusion in liver transplantation (LT) after the introduction of the thromboelastometry as intraoperative coagulation monitor. METHODS: We conducted a retrospective cohort study (n=92), randomized into two groups: groupA (control), in whom transfusion therapy was based on conventional laboratory tests (CLT), and groupB (ROTEM), whose blood transfusion was performed as protocolized algorithms, guided by thromboelastometry (ROTEM). We analyzed packed red blood cells (PRBCs) units, transfused units of fresh frozen plasma (FFP), platelets units, fibrinogen and tranexamic acid. We used the chi square test for the comparison of proportions and Student's t test to compare means when the distribution was normal. Otherwise, Mann-Whitney U test was performed. RESULTS: In groupA 84.8% of patients required transfusion of PRBCs, with a median (IQR) of 4 (1.5-6), compared with 67.4% in groupB with a median (IQR) of 2 (0-4) (P<.05). We also found differences in the following variables: FFP transfusion rate was 84.8% with a median (IQR) of 5 (2-12) IU in groupA and 56.5% (median (IQR) of 1 (0-4.5) in B (P<.001) and in the fibrinogen administration, that was 6.5% in groupA and 34.8% in groupB (P<.01). Backward stepwise logistic regression model showed associations between the clamping time, the preoperative hemoglobin, the portal hypertension (PHT) and being or not in the treatment group and the need for perioperative transfusion. We didn't find significant differences in the incidence of complication during the early postoperative period between the two groups. CONCLUSIONS: The introduction of thromboelastometry (ROTEM) measurements in hemostatic therapy algorithms reduces the transfusion rate of FFP and PRBCs during liver transplantation. The using of ROTEM derived thresholds leads to detecting higher requirements of fibrinogen compared to conventional laboratory tests.

Predicting fluid responsiveness in patients undergoing orthotopic liver transplantation: effects on intraoperative blood transfusion and postoperative complications.

OBJECTIVE: To test the hypothesis that the restrictive volume therapy decreases blood transfusion requirement during liver orthotopic transplantation (OLT) without increasing acute renal complications and hospital length stay. MATERIAL AND METHODS: We conducted a retrospective cohort study (n = 89), randomized into 2 groups: A (liberal fluid strategy) and B (restrictive therapy). We analyzed packed red blood cells (PRBCs) units, transfused units of fresh frozen plasma (FFP), colloids, crystalloids, perioperative renal function, and hospital length stay. For comparison of proportions, we used the χ(2) test and Student t test to compare means (parametric). A logistic regression model was constructed to evaluate the association of all these variables with probability of PRBCs transfusion. RESULTS: In group A, 88.4% of patients required intraoperative transfusion of PRBCs, with a mean of 8.5 ± 7.02 IU, compared with 82.2% in group B with a mean of 5.02 ± 4.5 IU (P < .001). We also found differences in the following variables: FFP transfusion rate was 95.3% (mean, 15.02 ± 8.2 IU) in group A and 75.6% (mean, 8.7 ± 6.04 IU) in B (P < .001). The amount of colloid was 50% (mean, 692.8 ± 409.6 mL) in group A and 28.9% (mean, 607.6 ± 316.7 mL) in B (P = .032). Platelet concentrates transfusion was 79.1% (mean, 2.05 ± 1.1 IU) in group A and 51.1% (mean, 2.0 ± 1.08 IU) in B (P = .014). As an important effect of restrictive fluid therapy, renal function was assessed; no differences in mean creatinine or acute renal failure in the immediate postoperative period were observed. There was no difference in hospital length stay. Logistic regression modelling identified 3 variables as significant predictors of transfusion: Fluid administration policy, preoperative hemoglobin and FFP units transfused. Furthermore, an increase of preoperative hemoglobin is associated with a lesser probability of transfusion. CONCLUSIONS: These results show that fluid restriction management for OLT decreased blood products requirements, especially FFP. This could suggest that liberal fluid management may aggravate, rather than prevent, bleeding in these patients. We did observed any no difference in failure of renal function.

Characterization of Vibrio harveyi strains recovered from diseased farmed Senegalese sole (Solea senegalensis).

AIM: To characterize 16 Vibrio harveyi strains isolated from different epizootic outbreaks affecting farmed Senegalese sole. MATERIALS AND RESULTS: The Vibrio harveyi strains tested have broad phenotypic diversity based on their biochemical and exoenzymatic patterns, outer membrane proteins (OMP), extracellular product (ECP) patterns and presence of prophages. Lethal dose 50 (LD(50)) of the strains and in vitro antagonism tests with two probiotic strains were also determined. The OMP analysis revealed three different patterns (A, M and V). The electrophoretic analysis of the ECP showed two different groups. All strains considered virulent based on their LD(50) exhibited the same protein pattern in their ECP (pattern I), while all nonvirulent strains showed a different profile (pattern II). About 32% of the tested strains were positive for prophages, although a clear relationship between virulence and the presence of prophages has not been established. CONCLUSIONS: The results obtained have shown differences between virulent and avirulent strains isolated from diseased farmed Senegalese sole based on the protein patterns of their ECP. However, a clear relationship between virulence and presence of prophages has not been established. SIGNIFICANCE AND IMPACT OF THE STUDY: The differences observed between virulent and nonvirulent strains could be used to design prophylactic strategies against diseases caused by V. harveyi in farmed Senegalese sole.

Interactions of microorganisms isolated from gilthead sea bream, Sparus aurata L., on Vibrio harveyi, a pathogen of farmed Senegalese sole, Solea senegalensis (Kaup).

Four bacterial isolates from farmed gilthead sea bream, Sparus aurata, included in a previous study as members of the Vibrionaceae and Pseudomonodaceae and the genus Micrococcus, have been evaluated for their adhesive ability to skin and intestinal mucus of farmed Senegalese sole, Solea senegalensis, and their antagonistic effect on Vibrio harveyi, a pathogen of sole. These isolates showed higher adhesion to sole mucus than the pathogenic strains of V. harveyi assayed. Only two of the isolates showed antagonistic activity to V. harveyi. Interactions of the four isolates with V. harveyi in respect of adhesion to skin and intestinal mucus under exclusion, competition and displacement conditions were studied. Three isolates were able to reduce the attachment to skin and intestinal sole mucus of a pathogenic strain of V. harveyi under displacement and exclusion conditions, but not under competition conditions. The in vivo probiotic potential of isolate Pdp11 was assessed by oral administration followed by challenge with the pathogenic V. harveyi strain Lg14/00. A group of 50 Senegalese sole received a commercial diet supplemented with 10(8) cfu g(-1) of lyophilized Lg14/00 for 15 days. A second group of fish received a non-supplemented commercial diet. After challenge the mortality of the fish receiving the diet supplemented with the potential probiotic isolate was significantly lower than that in the fish receiving the non-supplemented commercial diet. This study has shown that the ability to interfere with attachment of pathogens, as well as the adhesion to host surfaces, are suitable criteria for selection of candidate probiotics for use in the culture of Senegalese sole.

Adhesion to sole, Solea senegalensis Kaup, mucus of microorganisms isolated from farmed fish, and their interaction with Photobacterium damselae subsp. piscicida.

Abstract Most studies carried out to select microorganisms as candidate probiotics have focused on in vitro antagonism tests, such as the production of inhibitory compounds against pathogenic microorganisms. However, attachment to mucous surfaces could be another criterion to be considered when selecting potential probiotics for aquaculture. Nineteen isolates obtained from farmed Senegalese sole, Solea senegalensis Kaup, and gilthead sea bream, Sparus aurata L., have been evaluated for their capacity to adhere to skin and intestinal mucus of Senegalese sole, and their antagonistic effect against Photobacterium damselae subsp. piscicida, an important pathogen for farmed sole. The isolates from gilthead sea bream showed the highest percentage of adhesion to sole mucus, whilst the pathogenic microorganisms assayed and the isolates from sole showed, in general, a lower ability to adhere to sole mucus. The results suggest that the adhesion to fish mucus was more dependent on the isolate tested than on the host mucus. The isolates from gilthead sea bream also showed a higher antagonistic activity against P. damselae subsp. piscicida than those from Senegalese sole. Four isolates were selected, on the basis of their adhesive ability and antagonistic effect on P. damselae subsp. piscicida, to study their interactions with the pathogen in respect of adhesion to skin and intestinal mucus under exclusion, competition and displacement conditions. The results obtained show the ability of three isolates to reduce the adhesion of P. damselae subsp. piscicida to sole mucus under displacement and competition conditions. The adhesion of the pathogen to sole intestinal mucus was also significantly reduced when three isolates were assayed under exclusion conditions.