Approach to the liver transplant early postoperative period: na institutional
            standpoint

Amaral, Beatriz; Vicente, Madalena; Pereira, Carla; Araújo, Teresa; Ribeiro, Ana Isabel; Pereira, Rui; Perdigoto, Rui; Marcelino, Paulo

doi:10.5935/0103-507x.20190076

Cited by 11 publications

(16 citation statements)

References 49 publications

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“…Foram encontradas em 33,33% (6/18) dos artigos alterações hidroeletrolíticas e acidobásicas como uma das complicações mais frequentes, não apenas em pacientes transplantados, mas nos pacientes cirúrgicos em geral. 1,2,[5][6][7][8] .…”

Section: Resultsunclassified

Alterações Hidroeletrolíticas E Acidobásicas No Pós-Operatório Imediato Do Transplante De Fígado: Uma Revisão Qualitativa

Martins

Fonseca-Neto

2021

bjt

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Introdução: O pós-operatório imediato do transplante de fígado (TF) é um período instável e que necessita de controle e monitorização do paciente. Alterações hidroeletrolíticas e acidobásicas são apenas uma das várias complicações do pós-operatório imediato de TF, mas chamam muita atenção, e precisam de rápido e correto manejo. Objetivo: Busca-se através desta revisão avaliar as principais alterações acidobásicas e hidroeletrolíticas no pós-operatório imediato dos pacientes transplantados de fígado. Métodos: Trata-se de uma revisão, um estudo qualitativo com pesquisa em bancos de dados do MEDLINE, através do National Center of Biotechnology Information, acessando o site Pubmed. Os critérios de inclusão foram: (1) publicações em língua inglesa, (2) serem artigos originais ou revisão de literatura e (3) estarem em concordância com tema. Resultados: Cerca de mais de 70% dos pacientes, segundo os artigos analisados, apresentam acidose metabólica no pós-operatório imediato do TF, associada à hipercloremia. Os níveis de sódio são os mais alterados com a hiponatremia. Em média, 20% dos pacientes apresentam hipercalemia após transplante de fígado. Hipocalcemia, hipomagnesemia e hipofosfatemia são distúrbios muito frequentes nesses pacientes. Conclusões: Acidose metabólica associada à hipercloremia, hiponatremia, hipocalcemia e hipercalemia são os distúrbios mais comuns no pós-operatório mediato de TF.

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Section: Resultsunclassified

Alterações Hidroeletrolíticas E Acidobásicas No Pós-Operatório Imediato Do Transplante De Fígado: Uma Revisão Qualitativa

Martins

Fonseca-Neto

2021

bjt

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“…Fluid management is essential to maintain blood flow to the graft and adequate systemic blood pressure, while avoiding high volume loading 66. Besides that, the inflammatory status, which is characterized by increased capillary permeability and consequent fluid redistribution to the interstitial space; frequent ascites; and pleural effusions can change the disposition of water‐soluble antimicrobials by causing dilution in the extracellular compartment 67…”

Section: Pathophysiological Variables After Liver Transplantationmentioning

confidence: 99%

“…[66] Besides that, the inflammatory status, which is characterized by increased capillary permeability and consequent fluid redistribution to the interstitial space; frequent ascites; and pleural effusions can change the disposition of water-soluble antimicrobials by causing dilution in the extracellular compartment. [67] Higher volumes of distribution of cefotaxime and vancomycin reported in liver transplantation recipients were attributed to large amounts of fluid replacement during surgery. [16,21] Perioperative piperacillin levels were below the MIC of Pseudomonas aeruginosa after 4 h and were insufficient against the majority of Enterobacterales after 6 h due to a marked increase in the volume of distribution, suggesting the need to shorten interval.…”

Section: Fluid Therapymentioning

confidence: 99%

Pharmacokinetic and pharmacodynamic considerations of antibiotics and antifungals in liver transplantation recipients

Morales

Telles

Kwiatkowski

et al. 2022

Liver Transplantation

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The liver plays a major role in drug metabolism. Liver transplantation impacts the intrinsic metabolic capability and extrahepatic mechanisms of drug disposition and elimination. Different levels of inflammation and oxidative stress during transplantation, the process of liver regeneration, and the characteristics of the graft alter the amount of functional hepatocytes and activity of liver enzymes. Binding of drugs to plasma proteins is affected by the hyperbilirubinemia status and abnormal synthesis of albumin and alpha‐1‐acid glycoproteins. Postoperative intensive care complications such as biliary, circulatory, and cardiac also impact drug distribution. Renally eliminated antimicrobials commonly present reduced clearance due to hepatorenal syndrome and the use of nephrotoxic immunosuppressants. In addition, liver transplantation recipients are particularly susceptible to multidrug‐resistant infections due to frequent manipulation, multiple hospitalizations, invasive devices, and frequent use of empiric broad‐spectrum therapy. The selection of appropriate anti‐infective therapy must consider the pathophysiological changes after transplantation that impact the pharmacokinetics and pharmacodynamics of antibiotics and antifungal drugs.

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“…Ischemia and reperfusion injury (IRI) is a common complication, capable of hindering the success of the growing number of liver surgeries [1] due to the development of oxidative stress and inflammation [2,3]. The current therapy for liver IRI includes non-steroid antiinflammatory drugs (NSAID) and corticosteroids that do not achieve the desirable efficacy and additionally can present severe side effects [4].…”

Section: Introductionmentioning

confidence: 99%

Quercetin Liposomal Nanoformulation for Ischemia and Reperfusion Injury Treatment

et al. 2022

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Ischemia and reperfusion injury (IRI) is a common complication caused by inflammation and oxidative stress resulting from liver surgery. Current therapeutic strategies do not present the desirable efficacy, and severe side effects can occur. To overcome these drawbacks, new therapeutic alternatives are necessary. Drug delivery nanosystems have been explored due to their capacity to improve the therapeutic index of conventional drugs. Within nanocarriers, liposomes are one of the most successful, with several formulations currently in the market. As improved therapeutic outcomes have been demonstrated by using liposomes as drug carriers, this nanosystem was used to deliver quercetin, a flavonoid with anti-inflammatory and antioxidant properties, in hepatic IRI treatment. In the present work, a stable quercetin liposomal formulation was developed and characterized. Additionally, an in vitro model of ischemia and reperfusion was developed with a hypoxia chamber, where the anti-inflammatory potential of liposomal quercetin was evaluated, revealing the downregulation of pro-inflammatory markers. The anti-inflammatory effect of quercetin liposomes was also assessed in vivo in a rat model of hepatic IRI, in which a decrease in inflammation markers and enhanced recovery were observed. These results demonstrate that quercetin liposomes may provide a significant tool for addressing the current bottlenecks in hepatic IRI treatment.

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Approach to the liver transplant early postoperative period: na institutional standpoint

Cited by 11 publications

References 49 publications

Alterações Hidroeletrolíticas E Acidobásicas No Pós-Operatório Imediato Do Transplante De Fígado: Uma Revisão Qualitativa

Alterações Hidroeletrolíticas E Acidobásicas No Pós-Operatório Imediato Do Transplante De Fígado: Uma Revisão Qualitativa

Pharmacokinetic and pharmacodynamic considerations of antibiotics and antifungals in liver transplantation recipients

Quercetin Liposomal Nanoformulation for Ischemia and Reperfusion Injury Treatment

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