time was higher for STSCC (39 minutes vs. 30, p < 0.01). There was no difference in total graft ischemia time (345 min vs. 345, p = 0.933) and operative time was significantly reduced (246 min vs. 303, p < 0.01). STSCC was associated with significantly reduced intraoperative blood loss (3 vs. 6 liters), red blood cell transfusions (2 units vs. 4), fresh frozen plasma (6 units vs. 9), cell saver (0.8 L vs. 2), and rates of temporary abdominal closure (4% vs. 22%) compared to TP (all p < 0.05).Postoperative intensive care unit transfusions were also significantly lower for STSCC, with 82% requiring no red blood cell transfusions. Conclusion: STSCC is superior to TP implantation with regard to technical ease, operative time, blood loss, and transfusion requirements during LT. Future studies evaluating long-term outcomes including graft and patient survival following STSCC are warranted.
Liver ischemia–reperfusion (IR) injury is associated with poor outcome after liver transplantation and liver resections. Hexafluoroisopropanol (HFIP) is a tri‐fluorinated metabolites of volatile anesthetics and has modulatory effects on inflammation that have been observed mainly in cell culture experiments. In this survey, we investigated the effects of HFIP in a rat model of normothermic hepatic ischemia–reperfusion injury. Twenty‐four male Wistar rats were randomized into three groups: (1) control in which animals were submitted to 30 min of partial liver ischemia with resection of non‐ischemic liver lobes immediate after reperfusion, (2) pre‐ischemia (PI) group in which animals received intravenous HFIP (67 mg/kg) 5 min before liver ischemia, and (3) pre‐reperfusion (PR) group in which animals received intravenous HFIP (67 mg/kg) 5 min before reperfusion. Four hours after reperfusion, all animals were euthanized for sample collection. Aspartate and alanine transaminases, glucose, and high mobility group box‐1 (HMGB‐1) protein concentrations showed a significant decreased, and malondialdehyde was increased in the PR group compared with control and PI groups. Interleukin 6 (IL‐6) was increased in the PI group compared with control and PR groups. IL‐10 and ‐12 were increased in the PR and PI groups, respectively, when compared with the control group. Glucose decreased in the PR when compared with the control group. Post‐conditioning with HFIP led to a decrease in hepatocellular injury and was associated with a downregulation of HMGB‐1. The HFIP resulted in a better control of inflammatory response to ischemia–reperfusion even without causing a reduction in oxidative stress.
Tranjugular intrahepatic portosystemic shunt (TIPS) has became increasingly relevant in controlling recurrent variceal bleeding and intractable ascites in patients with portal hypertension due to advanced liver cirrhosis. Complications and success rate seem to be related to the pre-procedure conditions of the patients. The endopoints of this study are to value outcome of patients with variceal bleeding and ascites. Methods: Between 2013 and 2017, 41 patients with mean age 58.6 AE 10.9 years, underwent TIPS. Indications were variceal bleeding in 20 patients, ascites in 19 patients, both in 1 and post-LT (liver transplantation) in 1 patient; in 3 patients the procedures were subsequent to LT and in other 10 patients were carried out as bridge to LT. Clinical status was assessed according to the model of end-stage liver disease (MELD), pre and post-TIPS gradient pressure were measured, as well as ammonemia level. Outcome was valued assessing recurrence of bleeding or ascites and survival. Results: Pre and post-TIPS comparison showed a statistically significant reduction in portal pressure gradient (18.4 vs 10.5 mmHg) with an increase in ammonemia level (49.4 vs 59.5 mmol/L) without clinical syptoms; however no differences were observed in MELD (13.8 vs 14.3). Bleeding and ascites recurred in 4 out of 21 patients and in 14 out of 20 patients, respectively. Encephalopathy was present in 11 patients. Overall actuarial survival was 82%, 74% and 47% at 6, 12 and 24 months, respectively. Conclusion: TIPS seems to reduce more efficacy the risk of bleeding than ascites without modifying liver function.
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