Normothermic sanguineous oxygenated perfusion is a superior method of preservation compared with simple cold storage in UW solution. In addition, perfusion allows the possibility to assess viability of the graft before transplantation.

Machine perfusion of livers may provide a mechanism for extended preservation of marginal donor organs before transplantation, as well as a method for viability assessment. It has proved possible in a series of experimental porcine liver perfusions to maintain liver viability for up to 72 h. However, a reduction in bile production with associated histological evidence of cholestasis was seen after 10 h of perfusion, damaging the biliary canaliculi during the preservation period and leaving these organs in an unacceptable condition for transplantation. It was proposed that reduction in bile production was the result of a relentless depletion of available bile salts, gut recirculation not being possible and de-novo synthesis being unable to keep up with loss. This was proved by measuring porcine native bile acids within serial perfusate and bile samples using gas chromatography mass spectrophotometry. It was shown that all three native pig bile acids were decreased to 30% of their original value by 20 h of unsupplemented perfusion. An infusion of taurocholate managed to maintain bile production at physiological levels throughout the 20-h period (8 mL/h ∫ 0.75). It was successfully incorporated by the porcine livers into bile. We propose to use this circuit as a novel means of preserving donor livers for transplantation in which the organ is maintained at normal body temperature and perfused with blood. This will reduce ischaemia reperfusion injury and may enable prolonged preservation. The modification described ensures optimal bile production over the entire perfusion period, preventing inspissation and subsequent damage to the canaliculus.

Quantifying the transcriptomic ratios MMP8/HLA-DRA, LCN2/HLA-DRA by ddPCR is a promising approach to improve sepsis diagnosis in surgical patients.

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Glycohydrolases are a group of enzymes contained predominantly within lysosomes, which are released during Kupffer cell activation or death. One of these, ␤-galactosidase, has been proposed as a marker of ischemia-reperfusion injury in the liver because Kupffer cell activation represents a primary event in the injurious reperfusion cascade. In this study, we compared B-galactosidase with more traditional indicators of liver injury and function in a porcine model of liver preservation. Porcine livers were allocated into two groups: group C (n ‫؍‬ 5), preserved in University of Wisconsin solution by standard cold storage for 24 hours, and group W (n ‫؍‬ 5), perfused with oxygenated autologous blood on an extracorporeal circuit for 24 hours. Both groups were subsequently tested on the circuit during a 24-hour reperfusion phase. The perfusate was sampled for levels of ␤-galactosidase, as well as traditional markers of liver injury and function. A sharp increase in ␤-galactosidase levels was seen on reperfusion of cold preserved livers to a level of 1,900 IU/mL. This contrasted dramatically with normothermically preserved livers, in which the level never exceeded 208 IU/mL (P ‫؍‬ .002). ␤-Galactosidase levels showed much earlier and greater increases compared with transaminase levels in livers injured by ischemia. A rapid elevation in ␤-galactosidase levels corresponded well with poor liver function and more liver injury. Measurement of ␤-galactosidase is a simple test that quantifies ischemia-reperfusion injury of preserved livers. It is more sensitive than transaminases, with faster and larger increases in levels after ischemic injury. It can be useful in assessing the viability of a liver during machine preservation. (Liver Transpl 2002;8: 21-26.) L iver preservation currently does not provide a practical method to assess whether an organ will function adequately after transplantation. Because the liver must function in a timely fashion for a recipient to survive, livers are taken from good donors and rejected from marginal donors. Under pressing circumstances, when more marginal donors are used, the risk for primary nonfunction is increased. Therefore, an effective means of viability assessment would allow for the use of more marginal donors and minimize the risk for primary nonfunction by identifying nonviable organs.Glycohydrolases are cytosolic and lysosomal enzymes involved in carbohydrate metabolism that have been shown to increase markedly in serum after porcine liver transplantation. 1 A subsequent study specifically investigating the impact of warm ischemia time on glycohydrolase levels in the porcine model showed a correlation with ischemia time, and the pattern of recovery was different between livers that recovered function and those that did not. 2 The glycohydrolases found to be most useful in both these studies were ␤-galactosidase and ␤-glucoronidase.In this study, we investigated the use of a normothermic extracorporeal circuit to perfuse livers and provide an ischemia-free preservation period com...

Early recognition of sepsis is a key factor to improve survival to this disease in surgical patients, since it allows prompt control of the infectious source. Combining pro-inflammatory and immunosupression biomarkers could represent a good strategy to improve sepsis detection. Here we evaluated the combination of procalcitonin (PCT) with gene expression levels of HLA-DRA to detect sepsis in a cohort of 154 surgical patients (101 with sepsis and 53 with no infection). HLA-DRA expression was quantified using droplet digital PCR, a next-generation PCR technology. Area under the receiver operating curve analysis (AUROC) showed that the PCT/HLA-DRA ratio outperformed PCT to detect sepsis (AUROC [CI95%], p): PCT: 0.80 [0.73–0.88], <0.001; PCT/HLA-DRA: 0.85 [0.78–0.91], <0.001. In the multivariate analysis, the ratio showed a superior ability to predict sepsis compared to that of PCT (OR [CI 95%], p): PCT/HLA-DRA: 7.66 [1.82–32.29], 0.006; PCT: 4.21 [1.15–15.43] 0.030. Multivariate analysis was confirmed using a new surgical cohort with 74 sepsis patients and 21 controls: PCT/HLA-DRA: 34.86 [1.22–995.08], 0.038; PCT: 5.52 [0.40–75.78], 0.201. In conclusion, the combination of PCT with HLA-DRA is a promising strategy for improving sepsis detection in surgical patients.

Intestinal schistosomiasis as unusual aetiology for acute appendicitis, nowadays a rising disease in western countries. Recent changes in global migration has led to an immigration growth in our scenario, upsurging people coming from endemic areas of schistosomiasis. Schistosomal appendicitis, seldom reported in developed countries, is now an expected incrising entity in our hospitals during the near future. Due to this circumstances, we believe that schistosomiasis should be consider as a rising source for acute appendicitis in western countries. In order to illustrate this point, we present a case of a 45-years-old black man, from Africa, was admitted via A&E because of acute abdominal pain, located in right lower quadrant. Acute appendicitis was suspected, and he underwent laparotomy and appendectomy. Pathological study by microscope revealed a gangrenous appendix with abscesses and parasitic ova into the submucosal layer of the appendix, suggesting Schistosomiasis.