Liver Transplant Research Today is a free monthly online journal that collates and summarizes the latest research about Liver Transplant, including details on risks, prognosis, procedure, surgery, organ donation. | ||||||
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Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis.Biais M, Nouette-Gaulain K, Cottenceau V, Vallet A, Cochard JF, Revel P, Sztark F Service d'Anesthésie Réanimation I, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux Cedex, France. BACKGROUND: Cardiac output (CO) and invasive hemodynamic measurements are useful during liver transplantation. The pulmonary artery catheter (PAC) is commonly used for these patients, despite the potential complications. Recently, a less invasive device (Vigileo/FloTrac) became available, which estimates CO using arterial pressure waveform analysis without external calibration. In this study, we compared CO obtained with a PAC using automatic thermodilution, instantaneous CO stat-mode (ICO(SM)), and CO obtained with the new device, arterial pressure waveform analysis (APCO) in patients undergoing liver transplantation. METHODS: Twenty sets of simultaneous measurements of APCO and ICO(SM) were determined in sedated and mechanically ventilated patients undergoing liver transplantation. Time points were as follows: after PAC insertion (T1-3), after portal clamping (T4-6), during anhepathy (T7-9), after graft reperfusion (T10-15), and in the postoperative period in the intensive care unit (T15-20). RESULTS: We enrolled 20 patients and 400 measurements were obtained. No data were rejected. Bias between ICO(SM) and APCO was 0.8 L/min, 95% limits of agreement were -1.8 to 3.5 L/min. The percentage error was 43%. Bias between ICO(SM) and APCO was correlated with systemic vascular resistance [r(2) = 0.55, P < 0.0001, y = 15.8-2.2 ln(x)] and subgroup analysis revealed an increase in the bias and in the percentage error in patients with low systemic vascular resistance (Child-Pugh grade B and C patients). There was no difference between the different surgical periods. CONCLUSIONS: Our results suggest that Vigileo/FloTrac CO monitoring data do not agree well with those of automatic thermodilution in patients undergoing liver transplantation, especially in Child-Pugh grade B and C patients with low systemic vascular resistance. Published 18 April 2008 in Anesth Analg, 106(5): 1480-6, table of contents. Articles on Liver Transplant published 2 April 2008: Systemic transmigration of allosensitizing donor dendritic cells to host secondary lymphoid organs after rat liver transplantation. Hepatology, 47(4): 1352-62. Donor dendritic cell (DC) migration and allosensitization in host secondary lymphoid organs after liver transplantation are ill defined. We used rat models to investigate graft-derived cells and intrahost allosensitization. Liver transplantation induced diffuse blood-borne migration of donor major histocompatibility class II antigen-positive (MHCII(+)) cells and MHCI(+) cells from the graft to host secondary lymphoid organs, not only the spleen, but also lymph nodes and Peyer's patches. The ... [Abstract] [Full-text] Articles on Liver Transplant published 31 March 2008: Impact of localized congestion related to venous deprivation after hepatectomy. Surgery, 143(4): 483-9. OBJECTIVE: We sought to assess the impact of localized venous congestion related to venous deprivation on liver function recovery and regeneration after hepatectomy, using the living donation model. Harvesting the middle hepatic vein (MHV) optimizes the venous drainage of right grafts but could lead to donor segment IV congestion. METHODS: In a series of 44 donors, 25 underwent right liver harvesting without the MHV and 19 with the MHV. The venous drainage anatomy of segment IV was defined as ... [Abstract] [Full-text] Articles on Liver Transplant published 27 March 2008: Effect of multiorgan donation after cardiac death retrieval on lung performance. ANZ J Surg, 78(4): 262-5. AIM: For donation after cardiac death (DCD) transplantation to achieve its full potential, multiorgan retrieval is desirable. Although there are several novel individual techniques recently described for DCD lung donation, they have not been evaluated or compared in a DCD multiorgan scenario. DESCRIPTION: This study describes (i) the technical aspects and (ii) early lung and abdominal organ performance of several combinations of DCD donor liver, kidney and lung retrieval techniques that would ... [Abstract] [Full-text] Hepatocarcinoma in viral and metabolic liver disease. J Pediatr Gastroenterol Nutr, 46(4): 370-5. It is becoming increasingly evident that children, like adults, with chronic viral or metabolic liver diseases are at risk for the development of hepatocarcinoma. The aims of this article are to review the risk factors for hepatocarcinoma in chronic viral or metabolic liver disease, outline potential pathogenic mechanisms of hepatocarcinoma, and describe surveillance strategies, clinical evaluation, and management of hepatocarcinoma in children. [Abstract] [Full-text] Articles on Liver Transplant published 25 March 2008: Intraoperative placement of transparietohepatic biliary drainage in remedial hepaticojejunostomy: technique and clinical experience. Am J Surg, 195(4): 528-32. Remedial biliary surgery most often entails a Roux-en-Y hepaticojejunostomy. Sometimes the duct wall at the porta hepatis has been so damaged by inflammatory changes that the postoperative external drainage of bile away from a biliodigestive suture at risk of dehiscence is advisable. A technique of intraoperative placement of transparietohepatic biliary drainage was devised. The maneuver implies retrograde cannulation of a major intrahepatic duct with a vascular irrigation needle that is pushed ... [Abstract] [Full-text] Articles on Liver Transplant published 24 March 2008: Acquired cutaneous lymphangiectasia with mesothelial cells reflux in a patient with cirrhotic ascites. Am J Dermatopathol, 30(2): 140-4. A previously undescribed case of acquired cutaneous lymphangiectasias on the abdomen in a patient with cirrhotic ascites where peritoneal mesothelial cells refluxed in the skin is discussed. A 56-year-old man previously submitted to liver transplantation presented with vesiculobullous lesions on the developed as his cirrhotic ascites progressed. Histology showed dilated lymphatic channels in the upper dermis lined by a single, discontinuous layer of flattened, monomorphous endothelial cells ... [Abstract] [Full-text] Articles on Liver Transplant published 21 March 2008: Doppler sonography to diagnose venous congestion in a modified right lobe graft after living donor liver transplantation. AJR Am J Roentgenol, 190(4): 1010-7. OBJECTIVE: The objective of our study was to assess the value of Doppler sonography for the diagnosis of hepatic venous congestion in a modified right lobe graft during the early postoperative period after living donor liver transplantation. SUBJECTS AND METHODS: Doppler sonography examinations were prospectively performed in 54 patients within 24 hours after living donor liver transplantation with a modified right lobe graft in which large (> 5 mm) middle hepatic vein (MHV) tributaries were ... [Abstract] [Full-text] Articles on Liver Transplant published 18 March 2008: Hepatocellular carcinoma in HIV patients treated by liver transplantation. Eur J Surg Oncol, 34(4): 422-7. INTRODUCTION: Several reports have shown the effectiveness of liver transplantation (LT) as a therapeutic option in HIV-patients affected by end-stage liver disease. HCC on cirrhosis is another major indication for LT. However, no reports, to our knowledge, have been published as yet addressing the important questions of indications and outcome of LT in HIV-patients with HCC, mainly because of concerns regarding a more aggressive course of HCC with respect to HCC seen in HIV-negative ... [Abstract] [Full-text] © 2005-2008 Liver Transplant Research Today. All Rights Reserved. |
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