Effects of the Hypnotic Agent on Primary Graft Dysfunction After Liver Transplantation.

BACKGROUND: Morbidity and mortality rates in orthotopic liver transplantation have decreased in the past few years. Risk factors related to severe postoperative complications, such as primary graft dysfunction, still need to be analyzed. We evaluated the influence of the hypnotic agent used during anesthesia on primary graft dysfunction. METHODS: We performed a retrospective analysis of 419 consecutive patients who received a liver transplant between 2005 and 2013 in a single center. We analyzed the incidence of primary graft dysfunction (defined as alanine aminotransferase or aspartate aminotransferase levels higher than 1500 IU/L on the first 3 days after surgery) and if the hypnotic agent was associated with this event. RESULTS: The incidence of primary graft dysfunction was 42.2% (114 patients), similar in both groups (propofol group, 89 patients, 43.2% and sevoflurane group, 25 patients, 39.1%). In the multivariate analysis, we did not find any relationship between the hypnotic agent (propofol or sevoflurane) and early graft dysfunction. CONCLUSIONS: In our patients, we found no differences in the incidence of liver graft dysfunction according to the hypnotic used during transplantation. We can suggest that both drugs (sevoflurane and propofol) are equally safe in orthotopic liver transplantation.

[Anatomopathological and biochemical correlation of lesions produced by standard and irrigated 4 mm radiofrequency catheters]. / Correlación anatomopatológica y bioquímica de las lesiones producidas por la radiofrecuencia con catéteres estándar e irrigados de 4 mm.

INTRODUCTION AND OBJECTIVES: The influence on the size of radiofrequency lesions by cooling of the tip of the electrode remains unclear. Moreover, the possible effects of two different cooling systems, closed and open, have not been well differentiated. We designed this study to compare both systems of irrigated-tip catheters and the lesions produced with standard 4 mm catheters and also to evaluate the pathological and biochemical marker release correlation (cardiac troponin I) in an experimental model. METHODS: The study was performed in 20 pigs. Applying between 1-8 radiofrequency pulses, at a power of 15, 25 or 50 watts, for 15-60 seconds to each animal. After 7 days, the pigs were sacrificed for anatomopathological study. RESULTS: A total of 54 lesions were produced, 25 with standard catheters and 29 with irrigated catheters. The mean volume of the lesions produced with standard catheters was 146 +/- 110 microl and with irrigated-tip catheters 856 +/- 864 microl (p < 0.001). Peak values of cardiac troponin I were also higher for irrigated catheters (18 +/- 15 ng/ml) than for standard (6.5 +/- 3 ng/ml). The correlation between the size of the lesion and the levels of cardiac troponin I were 0.86 and 0.79 with the standard and irrigated-tip catheters, respectively. The incidence of cratering was higher with standard catheters (60%) than with irrigated (27%). CONCLUSIONS: The lesions produced with an irrigated catheter are greater than those observed with standard catheters. The mean peak value of postablation cardiac troponin demonstrate a good correlation with the real size of the necrosis.