Comparison of in vivo and ex vivo porcine liver function using the same liver

Mets, Berend; Rose-Innes, C.; Lotz, Zoë; Hickman, Rosemary; Chalton, D. O.

doi:10.1016/s0168-8278(05)80513-6

Cited by 14 publications

(9 citation statements)

References 16 publications

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“…In addition, our results indicate that the uncoupled circuit provided an appropriate liver perfusion as the liver consumed the same amount of oxygen as direct ex vivo circulation. 10 Moreover, uncoupling the ex vivo liver circulation from the systemic circulation did not abolish the ex vivo hepatic functions. The urea was still produced, and the ammonia and lactic acid were metabolized by the ex vivo liver.…”

Section: Discussionmentioning

confidence: 97%

“…To maintain an appropriate liver perfusion, the required blood flow is approximately 0.8 to 1 ml/min -1 per g -1 of liver. 10 As in physiologic conditions, this flow is approximately 25% of the cardiac output. While connected, the supported patient would have this additional flow to be mobilized by its heart over several days.…”

Section: Discussionmentioning

confidence: 97%

“…5 The flow through the liver must be at an optimal value to maintain an appropriate liver perfusion, about 1.0 ml/min -1 .g -1 of ex vivo liver. 9,10 Although, tolerated without major difficulties when using small pig liver in clinical situations 5 owing to the moderate weight of the ex vivo liver, the use of human cadaveric livers could be problematic. Indeed, depending on the weight of the liver, ranging from 1200 to 1500 g, the ex vivo circuit flow could reach 25% of the patient's cardiac output.…”

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confidence: 99%

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Uncoupling the Systemic Circulation and the Ex Vivo Circuit During Experimental Isolated Liver Perfusion

Lhuillier

Pouyet²,

Mechet³

et al. 2006

ASAIO Journal

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Performing an ex vivo liver perfusion as a transient liver support requires perfusing the liver with a flow of 1 ml/min per kg of liver, which could reach 25% of the cardiac output when a human liver is used. This high flow could be detrimental in patients with acute liver failure. Therefore, in an ischemic-induced liver failure pig model, we developed a circuit allowing low flows going out of and into the systemic circulation, whereas the flow going through the ex vivo liver is maintained at a high value. This was obtained by uncoupling the ex vivo circuit from the systemic circulation. Ex vivo liver perfusion was performed in a closed circuit with a flow averaging 1 ml/min per kg of ex vivo liver (700 to 800 ml/min, according to the weight of the livers we used). It was linked to the systemic circulation with input and output flows equal to that used during hemodialysis (200 ml/min). Compared with previously reported direct circuits, this perfusion system was well tolerated from a circulatory point of view. After the induction of ischemic liver failure, the ex vivo liver perfusion led to an increase in urea, branched amino acids to aromatic amino acid ratio, and fractional clearance of indocyanine green and galactose and to a decrease in ammonia and lactic acid. This system allowed the ex vivo liver to keep its clearing properties despite a low extracorporeal flow. It represents an extracorporeal circuit that could be used in place of the direct extracorporeal high-flow liver perfusion.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

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Uncoupling the Systemic Circulation and the Ex Vivo Circuit During Experimental Isolated Liver Perfusion

Lhuillier

Pouyet²,

Mechet³

et al. 2006

ASAIO Journal

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“…A reduced bile secretion leads to intracellular accumulation of those compounds and subsequent liver function deterioration and biliary canaliculi damage . TA substitution has been demonstrated to have a positive effect on bile production . Thus, some human and porcine protocols included TA to maintain an adequate bile salt pool .…”

Section: Discussionmentioning

confidence: 99%

Perfusion settings and additives in liver normothermic machine perfusion with red blood cells as oxygen carrier. A systematic review of human and porcine perfusion protocols

et al. 2018

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Liver machine perfusion (MP) at normothermic temperature (NMP) is a promising way to preserve and evaluate extended criteria donor livers. Currently, no consensus exists in methodology and perfusion protocols. Here, the authors performed a systematic literature search to identify human and porcine studies reporting on liver NMP with red blood cells. A qualitative synthesis was performed concerning technical aspects of MP, fluid composition, gas supply, and liver positioning. Thirty-seven publications including 11 human and 26 porcine studies were considered for qualitative synthesis. Control mode, pressure, flow, perfusate additives, and targeted blood gas parameters varied across human as well as porcine studies. For future analyses, it is advisable to report flow adjusted to liver weight and exact pressure parameters including mean, systolic, and diastolic pressure. Parenteral nutrition and insulin addition was common. Parenteral nutrition included amino acids and/or glucose without lipids. Taurocholic acid derivatives were used as bile flow promoters. However, short-term human NMP without taurocholic acid derivatives seems to be possible. This finding is relevant due to the lack of clinical grade bile salts. Near physiological oxygen tension in the perfusate is doable by adjusting gas flows, while blood gas parameters regulation needs more detailed description.

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“…A CEC poderá, então, ser finalizada e, após a retirada das cânulas vasculares, correrá a reversão da anticoagulação pela heparina com protamina (72) .…”

Section: Aspectos Fisiológicos E Mecânicos Da Circulação Extracorpóreaunclassified

Avaliação das concentrações plasmáticas e da farmacocinética da cefuroxima administrada profilaticamente em pacientes submetidos à revascularização do miocárdio

Ferreira¹

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DEDICATÓRIAAos meus pais, Custódio e Sonia (in memoriam) pelo amor e pela educação que me deram.Ao Roberto, com quem divido a felicidade e as responsabilidades, pelo amor, companheirismo e incentivo. À Carolina, por me trazer a felicidade a cada manhã e por me fazer amar mais e compreender melhor meus pais.Aos meus avós, Jacira e Santino, por todo o cuidado, carinho e pela ternura da minha infância.Ao Cristiano, à Daniela e à Maria, irmãos, amigos, companheiros, sempre. Pelas brincadeiras espontâneas, cumplicidade, admiração, dedicação e simplicidade.Aos meus sogros, Sueli e Roberto, por terem me acolhido como filha, incentivando-me sempre e me ajudando nas dificuldades do dia a dia. AGRADECIMENTOSA Deus, por me permitir chegar aqui.Aos pacientes e seus familiares, que aceitaram participar deste estudo, enxergando um objetivo maior. Introdução e Objetivos:A circulação extracorpórea (CEC) pode alterar a cinética de fármacos, inclusive dos antibióticos. O objetivo deste estudo foi avaliar influência da CEC sobre a farmacocinética da cefuroxima e verificar se o esquema posológico proposto: 1, 5g em bolus, seguido por três bolus de 750 mg 6/6 horas por 24 horas, mantém concentrações plasmáticas adequadas em pacientes submetidos à revascularização do miocárdio (RM). Método: Foi realizado estudo prospectivo observacional com grupo controle comparando 10 pacientes submetidos à RM com CEC e 9 pacientes submetidos à RM sem CEC (Registro Clincal trials: NCT0122882). Amostras sanguineas foram coletadas sequencialmente após cada dose de antibiótico e analisadas por meio do método de cromatografia líquida de alta pressão (HPLC). Análise de variância (ANOVA) foi utilizada para a comparação das concentrações plasmáticas e Log-rank para comparar as curvas que avaliaram o tempo, após a administração da cefuroxima, para que fossem atingidas concentrações abaixo de 16 g/mL (quatro vezes a MIC-mínima inhibitory concentration); considerando p< 0,05. Resultados: A CEC com tempo médio de 59,7 min  21,1 minutos não alterou a farmacocinética ou as concentrações plasmáticas da cefuroxima. O clearance médio  dp (mL/ Kg/ min) e a mediana da concentração mínima (mg/ dL) do grupo RM com CEC versus RM sem CEC foram 1,7  0,7 versus 1,6  0,6 (p= 0,67) e 6,1 versus 5,7 (p= 0,77), respectivamente. Ambos os grupos apresentaram diminuição nas concentrações plasmáticas influenciadas somente pelo tempo, após cada bolus de cefuroxima (p< 0,001). Concentrações acima de quatro vezes a MIC foram mantidas por três horas, por todos os pacientes, porém, após seis horas do primeiro bolus a probabilidade de manutenção das mesmas concentrações foi de 0,2 para o grupo RM com CEC e de 0,44 para o grupo RM sem CEC, p= 0,867. Após os demais bolus concentrações abaixo de 16 g/mL foram atingidas antes de três horas. Conclusão: A CEC não influenciou as concentrações plasmáticas ou a farmacocinética da cefuroxima. Os resultados da farmacocinética devem ser considerados para a escolha de um melhor esquema posológico. Background and Objectives: Cardiopulmonary by...

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Comparison of in vivo and ex vivo porcine liver function using the same liver

Cited by 14 publications

References 16 publications

Uncoupling the Systemic Circulation and the Ex Vivo Circuit During Experimental Isolated Liver Perfusion

Uncoupling the Systemic Circulation and the Ex Vivo Circuit During Experimental Isolated Liver Perfusion

Perfusion settings and additives in liver normothermic machine perfusion with red blood cells as oxygen carrier. A systematic review of human and porcine perfusion protocols

Avaliação das concentrações plasmáticas e da farmacocinética da cefuroxima administrada profilaticamente em pacientes submetidos à revascularização do miocárdio

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