Ammonia levels as early markers of good graft revascularization in hepatic transplantation

Anesthesia management in living-donor liver transplantation in a patient with carbamoyl phosphate synthetase deficiency: a case report

“…In adult LDLT for end-stage liver dysfunction, serum ammonia increases transiently during the anhepatic phase and returns to normal levels after reperfusion when the transplanted liver starts reworking. The normalization of serum ammonia indicates a well-functioning liver graft in the acute phase of LT, and [ 8 ] increased serum ammonia over 200 mcmol/L causes cerebral edema and intracranial hypertension; therefore [ 1 ], hyperammonemia should be avoided in such patients. In our case, serum ammonia was measured every 2 h, and critical hyperammonemia was not observed during surgery.…”

“…Serum ammonia was 29 mmol/L after anesthesia induction (2), 61 mcmol/L in the anhepatic phase (3), 44 mcmol/L an hour after reperfusion (4), 50 mcmol/L 4 h after reperfusion (5), and 50 mcmol/L at the end of the operation (6). Serum ammonia decreased to 54 mcmol/L on POD 1 (7), 44 mcmol/L on POD 2 (8) and to the normal range on POD 3 (9). The horizontal dotted line indicates a normal level of 38.8 mcmol/L POD 2, and they finally decreased to the normal range on POD 3.…”