No abstract

Most prognostic parameters used in clinical routine today are not reliable enough in predicting a patient's vital threat posed by an UGI bleeding. Liver cirrhosis, on the other hand, is significantly more frequently associated with an increased risk to die after bleeding of an ulcer located at the posterior duodenal wall.

Liver transplantation (LT) in an adult with situs inversus (SI) is extremely rare and requires precise pre-operative management. A 48-yr-old male with SI suffering from alcoholic liver cirrhosis underwent LT at our institution in March 2003. Pre-operatively, liver anatomy was determined by CT scan, three-dimensional liver reconstruction and angiography. LT was performed using the Belghiti technique with side-to-side cavo-caval anastomosis, transplanting a graft from a donor with normal anatomy. Post-operatively, the patient recovered without major complications, except an epileptic event because of a central pontine myelinolysis, and he was discharged on the 25th post-operative day. Three months after surgery, the T-drain placed intra-operatively into the donor bile duct was removed; transplant perfusion and function were stable with an actual follow-up period of 24 months. LT in patients with SI is feasible. Pre-operative imaging with three-dimensional reconstruction is a beneficial tool for operation planning in patients with rare anatomic variations.

Summary Danshen (DS) is used for treatment of various ischemic events in the traditional Chinese medicine. Hence, this study was designed to investigate its effect on ischemia/reperfusion injury (IRI) after experimental kidney transplantation (eKTx). Nephrectomized Sprague–Dawley rats underwent eKTx. Some animals were infused with 1.5 ml DS 10 min before surgery. Kidney grafts were transplanted after cold storage for 20 h in Histidine–Tryptophane–Ketoglutarate solution. After reperfusion blood samples were collected for blood urinary nitrogen (BUN), creatinine, lactate dehydrogenase (LDH), and alanine transaminase. Further, tissue was assessed for morphologic and pathophysiologic changes. Donor preconditioning with DS (DS‐d) significantly decreased BUN, creatinine, LDH, and aspartate aminotransferase to 65–97% of controls while preconditioning of the recipient (DS‐r) decreased values to 58–82% (P < 0.05). Tubular damage and caspase‐3 decreased significantly in both DS‐d and DS‐r (DS‐d: 96% and 67%, DS‐r: 83% and 75% of controls) while heat shock protein 72 and superoxide dismutase increased significantly (DS‐d: 143% and 173%, DS‐r: 166% and 194% of controls). Further, inducible nitric oxide synthase and tumor necrosis factor‐α decreased (DS‐d: 84% and 61%, DS‐r: 79% and 67% of controls) after DS. Preconditioning of both donors and recipients with DS significantly reduces IRI and thus improves graft function after eKTx.

Summary Reperfusion injury remains one of the major problems in transplantation. Free radicals and disturbance of microcirculation are the supposed main contributors. Recent evidence shows that Danshen, a traditional Chinese drug used in vascular diseases, can scavenge radicals and improve microcirculation. This study investigates its effect on liver transplantation (LTx). Before organ recovery, female Sprague‐Dawley rats (210–240 g) received intravenous Danshen or the same volume of Ringer solution as control. LTx was performed after 1 h of cold storage. Microperfusion, leukocyte‐endothelium interaction and latex‐bead phagocytosis were evaluated with in vivo microscopy. Survival, transaminases and histology were assessed. Immunohistology was used for TNF‐α levels. anova and Fisher’s exact test were employed for statistical analyses as appropriate. Survival increased from 60% in controls to 100% (P < 0.05). AST and LDH decreased from 3969 ± 1255 U/l and 15444 ± 5148 U/l in controls to 1236 ± 410 U/l and 5039 ± 1594 U/l, respectively (P < 0.05). In vivo microscopy revealed decreased leukocyte‐adherence and increased blood flow velocity in sinusoidal zones after administration of Danshen (P < 0.05), while latex‐bead phagocytosis was found in 60% of controls (P < 0.05). The TNF‐α index decreased from 2.08 ± 0.09 in controls to 1.09 ± 0.09 (P < 0.05). This study clearly demonstrates hepatoprotective effects after experimental LTx, which can be explained via anti‐oxidative effects, improved microcirculation and decreased Kupffer cell activation.