scholarly journals Effect of Aprotinin on Liver Injury after Transplantation of Extended Criteria Donor Grafts in Humans: A Retrospective Propensity Score Matched Cohort Analysis

2021 ◽  
Vol 10 (22) ◽  
pp. 5232
Author(s):  
Anna B. Roehl ◽  
Anne Andert ◽  
Karsten Junge ◽  
Ulf P. Neumann ◽  
Marc Hein ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Propensity Score ◽  
Ischemia Reperfusion ◽  
Cohort Analysis ◽  
Organ Function ◽  
Extended Criteria Donor ◽  
Number Of Patients ◽  
Organ Quality ◽  
Early Graft ◽  
Early Allograft Dysfunction

The number of patients awaiting liver transplantation still widely exceeds the number of donated organs available. Patients receiving extended criteria donor (ECD) organs are especially prone to an aggravated ischemia reperfusion syndrome during liver transplantation leading to massive hemodynamic stress and possible impairment in organ function. Previous studies have demonstrated aprotinin to ameliorate reperfusion injury and early graft survival. In this single center retrospective analysis of 84 propensity score matched patients out of 274 liver transplantation patients between 2010 and 2014 (OLT), we describe the association of aprotinin with postreperfusion syndrome (PRS), early allograft dysfunction (EAD: INR 1,6, AST/ALT > 2000 within 7–10 days) and recipient survival. The incidence of PRS (52.4% vs. 47.6%) and 30-day mortality did not differ (4.8 vs. 0%; p = 0.152) but patients treated with aprotinin suffered more often from EAD (64.3% vs. 40.5%, p = 0.029) compared to controls. Acceptable or poor (OR = 3.3, p = 0.035; OR = 9.5, p = 0.003) organ quality were independent predictors of EAD. Our data do not support the notion that aprotinin prevents nor attenuates PRS, EAD or mortality.

Effect of Aprotinin on Liver Injury After Transplantation of Extended Criteria Donor Grafts in Humans: A Retrospective Propensity Score Matched Cohort Analysis

2020 ◽  
Author(s):  
Anna Roehl ◽  
Marc Hein ◽  
Anne Andert ◽  
Rolf Rossaint ◽  
Karsten Junge ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Propensity Score ◽  
Ischemia Reperfusion ◽  
Cohort Analysis ◽  
Organ Function ◽  
Extended Criteria Donor ◽  
Number Of Patients ◽  
Organ Quality ◽  
Early Graft ◽  
Early Allograft Dysfunction

Abstract Background: The number of patients awaiting liver transplantation still widely exceeds the number of donated organs available. Patients receiving extended criteria donor (ECD) organs are especially prone to an aggravated ischemia reperfusion syndrome during liver transplantation leading to massive hemodynamic stress and possible impairment in organ function. Previous studies have demonstrated aprotinin to ameliorate reperfusion injury and early graft survival. Methods: In this single center retrospective analysis of 84 propensity score matched patients out of 290 liver transplantation patients between 2010 and 2014 (OLT), we describe the association of aprotinin with postreperfusion syndrome (PRS), early allograft dysfunction (EAD: INR  1,6, AST/ALT >2000 within 7-10 days) and recipient survival. Results: The Incidence of PRS (52,4% vs 47,6%) and 30-day mortality did not differ (4.8 vs 0%; p=0.152) but patients treated with aprotinin suffered more often from EAD (64,3% vs 40,5%, p=0.029) compared to controls. Acceptable or poor (OR=3.3, p=0.035; OR=9.5, p=0.003) organ quality were independent predictors of EAD. Conclusion: Our data does not support the notion that aprotinin prevents nor attenuates PRS, EAD or mortality.

scholarly journals Impact of Graft Steatosis on Postoperative Complications after Liver Transplantation

2018 ◽  
Vol 04 (04) ◽  
pp. e188-e196 ◽  
Author(s):  
Emad Ahmed ◽  
Ashraf El-Badry ◽  
Federico Mocchegiani ◽  
Roberto Montalti ◽  
Asem Hassan ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Postoperative Complications ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Cohort Analysis ◽  
Survival Rates ◽  
P Value ◽  
Early Graft ◽  
Hospital Stays ◽  
The Impact

Background Steatotic grafts are more susceptible to ischemia-reperfusion injury than are normal grafts. Therefore, using steatotic grafts for liver transplantation (LT) is associated with high primary dysfunction and decreased survival rates. The aim of this study is to evaluate the impact of graft steatosis on post LT outcomes. Methods A retrospective cohort analysis of 271 LT recipients from 2005 to 2016 was performed and patients were classified based on two types of steatosis, macrosteatosis (MaS), and microsteatosis (MiS). Each category was subdivided into three groups according to the degree of steatosis: no (< 5%), mild (≥5 to < 30%), and moderate (≥30 to ≤60%). The primary hospital stays and 6-month postoperative complications were analyzed by the Clavien–Dindo classification system. Additionally, patient and graft survivals were studied. Results Significant differences were observed in grade III MaS (p-value = 0.019) and grade V MiS (p-value = 0.020). A high trend of early graft dysfunction was found in the moderate MaS and MiS groups; however, they were not statistically significant (p-value = 0.199 and 0.282, respectively). Interestingly, the acute cellular rejection (ACR) rate was found to be inversely proportional to the degree of steatosis in both categories but it did not reach a significant level (p-value = 0.161 and 0.111, respectively). Conclusion Excellent post LT long-term outcomes using grafts with mild and moderate steatosis were determined. Further studies are needed to evaluate the newly proposed relationship between ACR and steatosis.

scholarly journals Early Allograft Dysfunction Increases Hospital Associated Costs After Liver Transplantation—A Propensity Score–Matched Analysis

2020 ◽  
Author(s):  
Simon Moosburner ◽  
Igor M. Sauer ◽  
Frank Förster ◽  
Thomas Winklmann ◽  
Joseph Maria George Vernon Gassner ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Propensity Score ◽  
Allograft Dysfunction ◽  
Early Allograft Dysfunction

scholarly journals Primary graft dysfunction of the liver: definitions, diagnostic criteria and risk factors

2016 ◽  
Vol 14 (4) ◽  
pp. 567-572 ◽  
Author(s):  
Douglas Bastos Neves ◽  
Marcela Balbo Rusi ◽  
Luiz Gustavo Guedes Diaz ◽  
Paolo Salvalaggio
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Diagnostic Criteria ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Allograft Dysfunction ◽  
Pubmed Database ◽  
Early Allograft Dysfunction

ABSTRACT Primary graft dysfunction is a multifactorial syndrome with great impact on liver transplantation outcomes. This review article was based on studies published between January 1980 and June 2015 and retrieved from PubMed database using the following search terms: “primary graft dysfunction”, “early allograft dysfunction”, “primary non-function” and “liver transplantation”. Graft dysfunction describes different grades of graft ischemia-reperfusion injury and can manifest as early allograft dysfunction or primary graft non-function, its most severe form. Donor-, surgery- and recipient-related factors have been associated with this syndrome. Primary graft dysfunction definition, diagnostic criteria and risk factors differ between studies.

scholarly journals Recipient Hyperbilirubinemia May Reduce Ischemia-Reperfusion Injury but Fails to Improve Outcome in Clinical Liver Transplantation

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Mihai Oltean ◽  
Christian Barrenäs ◽  
Paulo Ney Martins ◽  
Gustaf Herlenius ◽  
Bengt Gustafsson ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Reperfusion Injury ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Risk Index ◽  
Graft Loss ◽  
Antioxidant Properties ◽  
First Year ◽  
Early Graft ◽  
High Bilirubin

Background.Exogenous bilirubin may reduce experimental ischemia-reperfusion injury (IRI) due to its antioxidant properties. We studied if early graft exposure to high bilirubin levels in the recipient affects the early IRI and outcomes after liver transplantation (LTx).Methods.In 427 LTx patients, the AUROC curve based on bilirubin and AST at day 1 identified a cutoff of 2.04 mg/dL for the recipient pretransplant bilirubin. Recipients were grouped as having low (group L,n=152) or high (group H,n=275) bilirubin. Both groups had similar donor-related variables (age, preservation time, donor BMI > 28, and donor risk index (DRI)).Results.Alanine (ALT) and aspartate (AST) aminotransferase levels were higher in group L at day 1; ALT levels remained higher at day 2 in group L. LTx from high risk donors (DRI > 2) revealed a trend towards lower transaminases during the first two days after transplantation in group H. One month and 1-year patient survival were similar in groups L and H. High preoperative bilirubin did not affect the risk for early graft dysfunction (EGD), death, or graft loss during the first year after transplantation nor the incidence of acute rejection. LTx using donors with DRI > 2 resulted in similar rates of EGD in both groups.Conclusion.Increased bilirubin appears to reduce the early IRI after LTx yet this improvement was insufficient to improve the clinical outcome.

scholarly journals Impact of Rifaximin Therapy on Ischemia/Reperfusion Injury in Liver Transplantation: A Propensity Score–Matched Analysis

2019 ◽  
Vol 25 (12) ◽  
pp. 1778-1789 ◽  
Author(s):  
Takahiro Ito ◽  
Kojiro Nakamura ◽  
Shoichi Kageyama ◽  
Islam M. Korayem ◽  
Hirofumi Hirao ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Propensity Score ◽  
Reperfusion Injury ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion

The role of microRNA in hepatic ischemia/reperfusion injury

MicroRNA ◽  
2020 ◽  
Vol 09 ◽  
Author(s):  
Chrysanthos D. Christou ◽  
Georgios Tsoulfas
Keyword(s):  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Clinical Manifestations ◽  
Diagnostic Procedures ◽  
Clinical Tool ◽  
Hepatic Ischemia ◽  
Humoral Factors ◽  
Early Graft ◽  
Hepatic Ischemia Reperfusion

Introduction: Ischemia-reperfusion (I/R) injuries are caused by complex interrelated mechanisms and pathways. Regarding the liver, I/R injuries and their clinical manifestations are crucial for the surgical outcome. Despite its importance, there is no broadly accepted therapy either for the prevention or for the management of I/R injury. I/R injury of the liver can occur either during hepatic surgery (warm) or during the transplantation procedure (cold). MicroRNAs play a pivotal role in the mechanism of I/R injury, as they regulate the expression of the cellular participants and humoral factors associated with I/R injury. Objective: In this review, we highlight the microRNAs that are involved in the I/R injury of the liver, and the molecular pathways that they regulate. In addition, we discuss the potential role of circulating microRNAs as biomarkers and their role as pharmacological targets in the prevention, diagnosis and treatment of I/R injuries. Method: We conducted a comprehensive review of the PubMed bibliographic database regarding microRNAs and I/R injuries of the liver. Results: In diagnostics, microRNA panels could replace invasive diagnostic procedures, relieving patients of the associated complications. In therapeutics, microRNA agomirs, antagomirs and other drugs can be used to shift the balance between proapoptotic and survival pathways, to alleviate the liver damage caused by I/R. In transplantation procedures, microRNA profiling could decrease the incidence of early graft dysfunction, especially regarding marginal grafts. Conclusion: Although microRNAs seem a very promising clinical tool in the management of I/R injuries, further research is required, until microRNAs become a novel tool in the diagnosis and monitoring of an I/R injury of the liver.

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