Effects of Initial Hepatic Artery Followed by Portal Reperfusion Technique on Deceased Donor Liver Transplant Outcomes

Introduction: Tacrolimus is a macrolide immunosuppressant. It has a narrow therapeutic index and serious side effects which necessitate monitoring of tacrolimus blood concentration. The trough concentration of the drug may also differ based on the type of liver transplant. This study was conducted to investigate differences in pharmacokinetics between transplant types and to determine tacrolimus population pharmacokinetic in liver transplant recipients in Saudi Arabia. Method: Patients on tacrolimus, as the main immunosuppressant, who underwent liver transplant throughout2012-2014 were retrospectively studied. Demographic characteristic, tacrolimus blood trough concentrations, liver, renal, biochemistry, and hematology lab results were all collected. The pharmacokinetic parameters were estimated assuming one compartment model. Results: Tacrolimus pharmacokinetic parameters were found to be as following; elimination rate constant () 0.094 ± 0.0123, apparent volume of distribution () 112.48±63.033 L/hr, elimination half-life () 7.46± 1.01 hr and apparent total body clearance () 10.27± 5.69 L/hr (mean ± SD). Statistically significant difference was found between living-donor and deceased-donor liver transplant with respect to apparent clearance and apparent volume of distribution. Living-donor liver transplant recipients have apparent volume of distribution of 97.39±47.00 L (mean ± SD) and an apparent clearance of 8.89±4.24L/hr (mean± SD). On the other hand, deceased-donor liver transplant has an apparent clearance of 12.97±7.09L/hr (mean ± SD) and an apparent volume of distribution of 142.17± 78.65 L (mean ± SD). Conclusions: Tacrolimus pharmacokinetics parameters were accurately determined in liver transplant recipients in Saudi Arabia. The results of the present study can be clinically used in the therapeutic drug monitoring of tacrolimus in the individualization of drug dosage and taking the appropriate clinical decisions to prevent allograft rejection.

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The Use And Benefits of 3D Digital Microscope In Hepatic Artery Reconstruction During Living Donor Liver Transplant

10.21203/rs.3.rs-865452/v1 ◽

2021 ◽

Author(s):

Ching-Min Lin ◽

Shih-Lung Lin ◽

Yu-Ju Hung ◽

Chia-En Hsieh ◽

Yao-Li Chen ◽

...

Keyword(s):

Liver Transplant ◽

Hepatic Artery ◽

Surgical Training ◽

Living Donor ◽

Donor Liver ◽

Conventional Microscope ◽

Living Donor Liver Transplant ◽

Digital Microscope ◽

Donor Liver Transplant ◽

Artery Reconstruction

Abstract Background: To compare the intraoperative process of hepatic artery anastomosis using conventional microscope and novel 3D digital microscope and to share our institute’s experience for better surgical training.Method: A retrospective cohort study with 46 hepatic artery reconstructions in living donor liver transplant patients via operational microscope (Control group) and 3D digital microscope Mitaka Kestrel View II (Study group). We then discuss and share our institution’s experience to improve surgical training. Results: Both operation instruments provide effective and comparable results. There was no statistical significance regarding operational objective results between conventional microscope and exoscope. Both instruments have no hepatic artery size limit, and both have complete vessel patency rate. Conclusions: There was no statistical differences regarding hepatic artery anastomosis between microscope and exoscope cohorts. However, exoscope provided better ergonomics in the operation room and lessen musculoskeletal strain, allowing surgeons to work in a more neutral and comfortable posture and allow first assistant to learn and assist more effectively. Using exoscope with micro-forceps and modified tie technique make artery reconstruction easier.

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