Pancreas preservation with HTK solution in the pig

Abstract Background The guidelines recommend pancreatic resection for grade III and IV pancreatic injuries. On the other hand, organ preservation is an important issue. Herein, we present the first case of pancreatic injury with major pancreatic duct (MPD) disruption that was treated with the combination of preoperative placement of endoscopic nasopancreatic drainage (ENPD) catheter and pancreas preservation surgery after endoscopic pancreatic stenting (EPS) failure. Case presentation A 70-year-old female diagnosed with pancreatic injury was admitted to our hospital. She was hemodynamically stable. ERP revealed MPD disruption, and EPS failed. An ENPD catheter was placed preoperatively at the site of injury. During laparotomy, we identified a partial-thickness laceration in the pancreatic body. At the site of injury, the tip of the ENPD catheter was found; therefore, the patient was diagnosed with grade III pancreatic body injury with MPD disruption. The extent of crush was not severe, and we had no difficulty in identifying the distal MPD segment. We inserted the ENPD catheter into the distal MPD segment. The ruptured MPD and the laceration was sutured, then pancreatic resection was prevented. She was discharged on POD 56. Conclusion The treatment strategy incorporated ERP, placement of an ENPD catheter preoperatively, and a simple surgery in a hemodynamically stable patient with pancreatic injury allows the pancreas and spleen to be preserved.

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Ischemia-Reperfusion Injuries Assessment during Pancreas Preservation

International Journal of Molecular Sciences ◽

10.3390/ijms22105172 ◽

2021 ◽

Vol 22 (10) ◽

pp. 5172

Author(s):

Thomas Prudhomme ◽

John F. Mulvey ◽

Liam A. J. Young ◽

Benoit Mesnard ◽

Maria Letizia Lo Faro ◽

...

Keyword(s):

Ex Vivo ◽

Ischemia Reperfusion ◽

Graft Function ◽

Impedance Analysis ◽

Experimental Models ◽

Caspase Activation ◽

Pancreas Perfusion ◽

Number Of Factors ◽

Pancreas Preservation ◽

Metabolite Concentrations

Maintaining organ viability between donation and transplantation is of critical importance for optimal graft function and survival. To date in pancreas transplantation, static cold storage (SCS) is the most widely practiced method of organ preservation. The first experiments in ex vivo perfusion of the pancreas were performed at the beginning of the 20th century. These perfusions led to organ oedema, hemorrhage, and venous congestion after revascularization. Despite these early hurdles, a number of factors now favor the use of perfusion during preservation: the encouraging results of HMP in kidney transplantation, the development of new perfusion solutions, and the development of organ perfusion machines for the lung, heart, kidneys and liver. This has led to a resurgence of research in machine perfusion for whole organ pancreas preservation. This review highlights the ischemia-reperfusion injuries assessment during ex vivo pancreas perfusion, both for assessment in pre-clinical experimental models as well for future use in the clinic. We evaluated perfusion dynamics, oedema assessment, especially by impedance analysis and MRI, whole organ oxygen consumption, tissue oxygen tension, metabolite concentrations in tissue and perfusate, mitochondrial respiration, cell death, especially by histology, total cell free DNA, caspase activation, and exocrine and endocrine assessment.

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Pancreas preservation for pancreas and islet transplantation

Current Opinion in Organ Transplantation ◽

10.1097/mot.0b013e3282f63942 ◽

2008 ◽

Vol 13 (2) ◽

pp. 135-141 ◽

Cited By ~ 18

Author(s):

Yasuhiro Iwanaga ◽

David ER Sutherland ◽

James V Harmon ◽

Klearchos K Papas

Keyword(s):

Islet Transplantation ◽

Pancreas Preservation

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Oxygen and Pancreas Preservation: Reply

Transplantation Journal ◽

10.1097/01.tp.0000191941.43260.48 ◽

2006 ◽

Vol 81 (3) ◽

pp. 492-493 ◽

Cited By ~ 1

Author(s):

Daniel Brandhorst ◽

Reinhard G. Bretzel ◽

Heide Brandhorst

Keyword(s):

Pancreas Preservation

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Ventricular Fibrillation After Release of an Aortic Cross-Clamp in Valvular Surgery: Independent Risk Factors, Outcomes, and Incidence from Access Routes

10.21203/rs.3.rs-697996/v1 ◽

2021 ◽

Author(s):

Weichao LI ◽

heng li ◽

Jianping Gong ◽

Weihua Liu ◽

BaoJun Fu ◽

...

Keyword(s):

Risk Factors ◽

Ventricular Fibrillation ◽

Clinical Outcomes ◽

Valve Replacement ◽

Smoking Status ◽

Left Ventricular ◽

Aortic Cross Clamp ◽

Valvular Surgery ◽

Htk Solution ◽

Independent Risk Factors

Abstract Background Predictors and clinical outcomes of VF-ACC and the relative VF-ACC incidence with various access routes have not been well documented. This study aimed to identify predictors, clinical outcomes, and relative incidences of ventricular fibrillation after the release of an aortic cross-clamp (VF-ACC) with various access routes in valvular surgery.Patients and methods In this single-center and retrospective cohort study, we screened 228 consecutive patients undergoing valve surgery, and a total of 119 patients were included in the study. The primary outcomes were the relative incidence and predictors of VF-ACC with access routes, and secondary endpoints included effects of VF-ACC on 30-day mortality, perioperative ventricular arrhythmias (VAs), and heart failure with ejection fraction < 50% (HFEF < 50%).Results VF-ACC incidence varied on the basis of access routes. VF-ACC occurred in 58.3% of patients with aortic valve replacement via transverse aortotomy (TAo-AVR), in 48.6% of patients with aortic and mitral replacements via transseptal and transverse aortotomy access (TSAo-MAVR), and in 20% of patients with mitral valve replacement via transseptal access (TS-MVR). Seven independent risk factors were identified: HTK solution (AOR: 4.90, p = 0.002), smoking status (AOR: 6.30, p = 0.001), cerebrovascular disease (CBD) [(AOR: 7.08, p = 0.022)], regional wall motion abnormality (RWMA) [(AOR: 8.33, p < 0.001)], perioperative VAs (AOR: 4.85, p = 0.001), HFEF < 50% (AOR: 5.66, p = 0.002), and left ventricular mass index (LVMI) [(AOR: 0.962, CI: 0.941–0.984)].Conclusions VF-ACC was the most common in TAo-AVR and the least common in TS-MVR. HTK solution, smoking status, CBD, perioperative VAs, HFEF < 50%, and RWMA were associated with an increased risk of VF-ACC, and low LVMI acted as a protective factor. Patients with VF-ACC commonly experienced perioperative VAs or HFEFs < 50%.Clinical trial registration: ChiCTR2100050961.

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