Portocaval Shunt Throughout Anhepatic Phase in Orthotopic Liver Transplantation for Cirrhotic Patients

2007 ◽  
Vol 39 (7) ◽  
pp. 2280-2284 ◽  
Author(s):  
I.L. de Cenarruzabeitia ◽  
J.L. Lázaro ◽  
I. Bilbao ◽  
J. Balsells
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Portocaval Shunt ◽  
Anhepatic Phase ◽  
Cirrhotic Patients

Evolution of Urokinase-Type Plasminogen Activator (u-PA) and Tissue-Type Plasminogen Activator (t-PA) in Orthotopic Liver Transplantation (OLT)

1993 ◽  
Vol 69 (01) ◽  
pp. 056-059 ◽  
Author(s):  
G Himmelreich ◽  
G Dooijewaard ◽  
P Breinl ◽  
W O Bechstein ◽  
P Neuhaus ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Plasminogen Activator ◽  
Orthotopic Liver Transplantation ◽  
Tissue Type ◽  
Bleeding Complications ◽  
Activity Levels ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator ◽  
Urokinase Type Plasminogen Activator ◽  
Anhepatic Phase

SummaryIn orthotopic liver transplantation (OLT) hyperfibrinolysis seems to be of causative importance for intra- and postoperative bleeding. Although recently hyperfibrinolysis has been successfully reduced by intraoperative aprotinin treatment, small increases of fibrinolysis still remain during OLT. Originally, tissue-type plasminogen activator (t-PA) was considered to be responsible for the increases, but the efficacy of aprotinin which inhibits besides plasmin also kallikrein and urokinase-type plasminogen activator (u-PA) suggested also a role for the intrinsic and contact system-dependent plasminogen activators. We investigated the role of u-PA. From 29 patients undergoing OLT with intraoperative aprotinin infusion arterial blood samples were taken at 7 different time points. The preoperative median values for u-PA antigen (u-PA Ag) and plasmin-activatable single-chain u-PA (scu-PA) levels, which were more than 2-fold above normal (both: p <0.01), decreased slightly during the preanhepatic phase and remained unchanged during the anhepatic phase. With reperfusion of the graft liver the two levels decreased significantly (p = 0.0003 and p = 0.006, respectively) to almost normal values, probably due to clearance by the graft liver. Active two-chain u-PA (tcu-PA) was preoperatively 2-fold above the detection limit, remained stable during the preanhepatic phase and increased 2-fold in the anhepatic phase (p = 0.0018). As expected tcu-PA also relapsed upon reperfusion, but to the preoperatively enhanced level, possibly caused by sustained activation of scu-PA by cathepsin B. t-PA activity levels were at the upper end of the normal range preoperatively, slightly increased during preanhepatic and anhepatic phases and decreased significantly with reperfusion. The increases in tcu-PA and t-PA activities during the anhepatic phase coincided with greatly increased fibrinolysis as demonstrated by thrombelastography, indicating that both u-PA and t-PA are involved in the development of fibrinolysis during OLT.One patient was excluded from statistical evaluations because preoperative u-PA Ag, scu-PA, tcu-PA and t-PA activity levels were much higher than in the other 28 patients. In the investigated group this patient was the only one with diffuse peritonitis intraoperatively and severe bleeding complications postoperatively which made retransplantation mandatory.

scholarly journals Hepatocellular carcinoma in patients undergoing orthotopic liver transplantation: radiological findings with anatomopathological correlation in Brazil

2006 ◽  
Vol 43 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Antônio Carlos Maciel ◽  
Carlos Thadeu Cerski ◽  
Roger Klein Moreira ◽  
Vinicius Labrea Resende ◽  
Maria Lúcia Zanotelli ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Orthotopic Liver Transplantation ◽  
Imaging Techniques ◽  
Arterial Phase ◽  
Hepatitis C Virus Infection ◽  
Cirrhotic Patients

BACKGROUND: Hepatocellular carcinoma is one of the most common malignant tumors worldwide. Imaging techniques, specially computed tomography and ultrasound, are among the most useful diagnostic tools, although the accuracy of these methods may have a significant variability. AIMS: To determine the prevalence of hepatocellular carcinoma in cirrhotic patients undergoing orthotopic liver transplantation at "Santa Casa de Misericórdia" of Porto Alegre, RS, Brazil; to estimate the sensitivity of computed tomography and ultrasound in pretransplantation detection of hepatocellular carcinoma in this population; to correlate the radiological characteristics with anatomopathological findings. MATERIALS AND METHODS: Retrospective prevalence study. Population: adult, cirrhotic patients undergoing orthotopic liver transplantation from January 1990 to July 2003. Among the 292 transplanted patients, 31 cases of hepatocellular carcinoma were diagnosed, of which 29 were included in the study. Tumor characteristics in both ultrasound and computed tomography were compared to those observed in anatomopathological examination. RESULTS: Prevalence of hepatitis C virus infection among patients with diagnosis of hepatocellular carcinoma was 93.5%, and the prevalence of hepatocellular carcinoma among transplanted patients was 10.6%. The overall sensitivity of the imaging techniques was 70.3% for computed tomography and 72% for ultrasound. CONCLUSION: The prevalence of hepatocellular carcinoma at our institution, as well as the sensitivity of both ultrasound and computed tomography to detect such tumors at pretransplantation screening were similar to those found by other authors, while the prevalence of hepatitis C virus infection, the most common etiological agent for liver disease in our patients, is one of the highest ever reported in literature. Factors influencing hepatocellular carcinoma detection rates were: time from examination to liver transplantation; acquisition of computed tomography images during arterial phase; lesion size. Arterial phase proved to be the most useful part of computed tomography examination in this study.

scholarly journals A.283 Pulmonary metabolism of propofol in pigs during anhepatic phase of orthotopic liver transplantation

1996 ◽  
Vol 76 ◽  
pp. 89
Author(s):  
Zeynep Eti ◽  
Tümay Umuroglu ◽  
Abdurrahman Yayci ◽  
Serpil Ustalar ◽  
F. Yilmaz Gögüç
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Anhepatic Phase

scholarly journals Hemodynamics alterations during orthotopic liver experimental transplantation in pigs

2008 ◽  
Vol 23 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Orlando Jorge Martins Torres ◽  
Patrícia Brandão Pantoja ◽  
Erica Sampaio Barbosa ◽  
Cristiany de Almeida Barros ◽  
Elizabeth Teixeira Noguera Servin ◽  
...  
Keyword(s):  
Heart Rate ◽  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Venous Pressure ◽  
Systemic Arterial Pressure ◽  
Blood Gas ◽  
Cold Ischemia ◽  
Central Venous ◽  
Anhepatic Phase ◽  
The Mean

PURPOSE: To describe the hemodynamics alterations during orthotopic liver transplantation in pigs. METHODS: In the period from April 2004 to December 2005, forty-four female Landrace pigs, weighting between 32 and 38 Kg were undergone to orthotopic liver transplantation. The animals were divided into two groups, donor and recipient pairs, which received whole liver grafts. The surgical procedure was divided into four parts: harvested, back-table, hepatectomy of the recipient and implantation. We analyze heart rate, blood gas, mean systemic arterial pressure (MAP-mmHg), central venous pressure, pH, Na-, K+, Cl-, Ca+ and urinary output. RESULTS: The mean anhepatic time was 69 min, cold ischemia was 252.2 min and back-table was 56.6 min. Blood pressure and heart rate dropped significantly during anhepatic phase and after revascularization. Blood gas and electrolytes alterations were observed during anhepatic and reperfusion phases. Although alterations were noted during these phases, the hemodynamic status was recovered and stabilized in the end of the surgery. CONCLUSIONS: Simplified technique of liver transplant was achieved and description of hemodynamic alterations was possible in pigs.

Dabigatran Reversal With Idarucizumab in 2 Patients With Portal Vein Thrombosis Undergoing Orthotopic Liver Transplantation

2021 ◽  
pp. 108925322098218
Author(s):  
Cynthia Williams ◽  
Erin Stewart ◽  
Kendra D. Conzen ◽  
Scott Wolf ◽  
Timothy T. Tran
Keyword(s):  
Liver Transplantation ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Orthotopic Liver Transplantation ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Case Series ◽  
Reversal Agent ◽  
Vein Thrombosis ◽  
Cirrhotic Patients

There are limited data to guide the use of anticoagulation in cirrhotic patients prior to liver transplantation especially when using direct oral anticoagulants. In this article, we present 2 cases. The first is a 42-year-old male with cirrhosis complicated by portal vein thrombosis (PVT) treated with dabigatran who underwent orthotopic liver transplantation without complication. The second case is a 65-year-old man with alcoholic cirrhosis complicated by PVT treated with dabigatran who underwent orthotopic liver transplantation and required reoperation for surgical bleeding. Both patients were treated with dabigatran’s reversal agent idarucizumab prior to incision. In this case series, we discuss the treatment of cirrhotic patients with various anticoagulants, considerations for anticoagulant selection and reversal prior to liver transplant, and questions for future investigation.

Plasma Concentrations of Laudanosine, but Not of Atracurium, Are Increased during the Anhepatic Phase of Orthotopic Liver Transplantation in Pigs

1990 ◽  
Vol 72 (1) ◽  
pp. 145-152 ◽  
Author(s):  
Jean-François Pittet ◽  
Edömer Tassonyi ◽  
Corinne Schopfer ◽  
Denis R. Morel ◽  
Gilles Mentha ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Plasma Concentrations ◽  
Anhepatic Phase
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