Coagulation changes and the influence of the early perfusate in the course of orthotopic liver transplantation (OLT) when aprotinin is used intra-operatively

Himmelreich, G.; Kierzek, B.; Neuhaus, P.; Slamer, K.-J.; Jochum, Marianne; Rieß, H.

doi:10.1097/00001721-199102000-00008

Cited by 40 publications

(35 citation statements)

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“…Primary tion of the graft, and are comprised by the term ''reperfusion graft viability is not fully preserved by simply flushing and syndrome.'' 26,27 storing the liver in ice-cold University of Wisconsin or A major concern in the conduction of the study was that Brettschneider's solution (HTK solution). Although studies enalapril may contribute considerably to the postreperfusion on modified flush solutions and pretreatment of recipients hemodynamic instability of recipients.…”

Section: ) Inmentioning

confidence: 99%

Angiotensin–Converting Enzyme Inhibition by Enalapril: A Novel Approach to Reduce Ischemia/Reperfusion Damage After Experimental Liver Transplantation

et al. 1997

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emia/reperfusion injury in clinical liver transplantaAngiotensin-converting enzyme (ACE) inhibitors tion. (HEPATOLOGY 1997; 25:648-651.) have proven to be effective in the reduction of ischemia/reperfusion damage after myocardial ischemia. Whether this favorable effect can be related to other models of ischemia and reperfusion has not After more than 20 years of clinical experience, liver transyet been investigated. Therefore, we studied in a plantation is an established treatment modality for end-stage model of syngeneic liver transplantation in the rat liver disease, acute liver failure, and selected hepatic maligthe effect of recipient enalapril treatment on post-nancies. 1,2 The timing of transplantation and selection of suitischemic liver injury. Untreated animals served as able donors and recipients are crucial cornerstones for a sucthe control group. Treatment with enalapril was cessful outcome of the costly procedure. In up to 22% of cases, started 5 minutes before reperfusion by intravenous primary graft dysfunction after transplantation is observed, infusion of enalapril at a dosage of 5 mg/kg/h. By initiating a cascade of severe postoperative complications means of in vivo microscopy, the sinusoidal perfusion with considerable impact on morbidity and mortality. 3 Pathorate and leukocyte adherence in sinusoids and post-physiologically, graft dysfunction is based on preexisting dosinusoidal venules were analyzed during 45 to 60 min-nor liver damage and insults from cold/warm ischemia and utes of reperfusion. Liver function was monitored by reperfusion. measuring bile output over a period of 60 minutes.In recent years, many attempts have been made to improve Analysis of coagulation factors (prothrombin time, organ preservation, e.g., to prolong the tolerable ischemic factor V, fibrinogen) and liver enzymes (alanine time, and to better protect the graft from both anoxic and transaminase [ALT], aspartate transaminase [AST]) oxygen free radical-mediated damage. Therapeutic strateserved for the evaluation of organ dysfunction and gies in recipients were aimed particularly at the reduction of damage secondary to ischemia/reperfusion injury. reperfusion injury mediated by oxygen free radicals, which The sinusoidal perfusion rate was significantly im-are generated with reoxygenation of the liver. Results in ani- first time that ACE inhibition in the liver recipient g body weight; recipients: 190-250 g) underwent orthotopic liver by enalapril attenuates hepatic ischemia/reperfusion transplantation according to the cuff technique described by Kamada damage after experimental liver transplantation. Our and Calne. 8 In contrast to Kamada's original technique, grafts were results may offer a novel approach to reduce isch-rearterialized and simultaneously reperfused by the portal and arterial route as described by Post et al. 9 Livers were preserved by retrograde aortal flush with University of Wisconsin solution and stored at 4ЊC for 24 hours. Before reperfusion, the grafts were flushed with 10 mL of Ringer's lactat...

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Section: ) Inmentioning

confidence: 99%

Angiotensin–Converting Enzyme Inhibition by Enalapril: A Novel Approach to Reduce Ischemia/Reperfusion Damage After Experimental Liver Transplantation

et al. 1997

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“…They found that 2 milion kallikrein inhibitory units (KIU) of aprotinin significantly decreased blood loss, transfusion of red blood cells, FFP use, and duration of surgery when compared to a patient group not given aprotinin. Their findings were supported by a subsequent report involving a small number of patients [22][23][24][25][26][27][28]. In 2000, Porte et al [29] reported the first multi centre, prospective, double-blinded, controlled trial of aprotinin in OLT A total of 141 patients were enrolled in the study.…”

Section: Aprotininmentioning

confidence: 75%

Re-Evaluation of the Role of Antifibrinolytic Therapy with Lysine Analogs in Liver Transplantation in The Post-Aprotinin Era

Lucci¹,

Dauri²

2012

J Anesth Clin Res

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“…Eine diffuse Nachblutung nach Reperfusion ist gewöhnlich von einer disseminierten intravasalen Gerinnung, Thrombocytopenie und Thrombocytendysfunktion begleitet [10]. In Anbetracht der Gefahr einer frühen postoperativen Nachblutung bei sich erst rekompensierender Gerinnung nach Transplantation stellt eine unmittelbar postoperativ einsetzende, systemische Anticoagulation scheinbar ein erhebliches Risiko dar.…”

Section: Orthotope Lebertransplantationunclassified

Behandlung des fortgeschrittenen Budd-Chiari-Syndroms durch Lebertransplantation

Knoop

Lang

Neumann

et al. 1998

Chirurg

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Budd-Chiari syndrome (BCS) with hepatic vein occlusion is a rare disorder that can effectively be treated in advanced stages with orthotopic liver transplantation. We report on 16 patients who received 18 liver grafts and were followed up for at least 2 years. In 7 patients a hematological disorder was confirmed by bone marrow biopsy. One patient died after 4 months due to cytomegalovirus pneumonia; another patient died after 2 years due to progressive liver failure after portal vein thrombosis. The actuarial 5-year survival rate is 87.5% compared to 85.3% in all other 710 orthotopic liver transplantations performed from September 1988 to December 1995 at our institution. Anticoagulation consisted of intravenous heparin and overlapping continuation with dicoumarin. Three patients received hydroxyurea for thrombocytosis, one patient for 1 week only early after the transplantation. Two postoperative abdominal hemorrhages required laparotomy. Two patients had to be retransplanted, one for thrombosis of the hepatic artery and portal vein after discontinuation of dicoumarin due to GI bleeding and one for hepatic vein thrombosis after insufficient dicoumarin intake. Terminal BCS represents a good indication for orthotopic liver transplantation; however, life-long, closely monitored anticoagulation is essential.

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Coagulation changes and the influence of the early perfusate in the course of orthotopic liver transplantation (OLT) when aprotinin is used intra-operatively

Cited by 40 publications

References 0 publications

Angiotensin–Converting Enzyme Inhibition by Enalapril: A Novel Approach to Reduce Ischemia/Reperfusion Damage After Experimental Liver Transplantation

Angiotensin–Converting Enzyme Inhibition by Enalapril: A Novel Approach to Reduce Ischemia/Reperfusion Damage After Experimental Liver Transplantation

Re-Evaluation of the Role of Antifibrinolytic Therapy with Lysine Analogs in Liver Transplantation in The Post-Aprotinin Era

Behandlung des fortgeschrittenen Budd-Chiari-Syndroms durch Lebertransplantation

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