Ischemia-Reperfusion Injury and Ischemic-Type Biliary Lesions following Liver Transplantation

Cursio, Raffaele; Gugenheim, Jean

doi:10.1155/2012/164329

Cited by 87 publications

(72 citation statements)

References 227 publications

(345 reference statements)

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“…2,9,[12][13][14][15][16] Transient liver dysfunction after liver transplant can potentially cause bleeding , thereby increasing the chance of coagulopathic hemorrhage. Our data show that patients who developed coagulopathic-related hemorrhage had significantly lower preoperative platelet counts, a longer cold ischemia time, and greater estimated blood loss than patients with noncoagulopathic-related hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Hsieh

Chou²,

Lin³

et al. 2017

Exp Clin Transplant

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Objectives: Our goal was to evaluate the predictors of coagulopathic hemorrhage after living-donor liver transplant. Materials and Methods:We retrospectively evaluated 161 patients who had undergone living-donor liver transplant from July 2005 to April 2014 at a single medical institution. Of these patients, 32 developed hemorrhage after transplant. Patients were separated into those with coagulopathy-related hemorrhage (n=15) or noncoagulopathy-related hemorrhage (n=17) based on the results of computed tomography images. Predictors of hemorrhage after living-donor liver transplant evaluated in this study included preoperative, perioperative, and posttransplant factors and hemodynamic status. Results: Patients who developed coagulopathy-related hemorrhage had significantly lower pretransplant platelet counts (P = .040), a longer cold-ischemia time (P = .045), more blood loss (P = .040), and earlier onset of hemorrhage (P = .048) than patients who had noncoagulopathy-related hemorrhage after transplant. Results of the generalized estimating equation analysis showed that heart rate and central venous pressure differed significantly between the 2 groups of patients. Heart rates increased significantly during hemorrhage (P < .010). Central venous pressure was higher in the coagulopathic group (P = .005) than in the noncoagulopathic group. Conclusions: Lower pretransplant platelet counts, longer cold ischemia time, more blood loss, earlier onset of hemorrhage, and higher central venous pressure level are indicators of coagulopathic hemorrhage after living-donor liver transplant. Key words: Central venous pressure, Cold ischemia time, Computed tomography IntroductionHemorrhage is one of the most common complications after liver transplant, especially during the first postoperative week. 1,2 There are many factors that contribute to postoperative hemorrhage, including the recipient's preoperative condition (for example, coagulopathy, thrombocytopenia), liver graft condition (donors > 60 years, steatosis), surgical technique (inadequate hemostasis of the cut surface of the remnant liver, blood loss from vascular anastomosis, and prolonged cold ischemia time), and recipient's postoperative condition (early graft dysfunction or primary nonfunction, use of heparin, vascular complications). [3][4][5][6] Regardless of the underlying causes of hemorrhage, hemorrhage after liver transplant can be classified as coagulopathic bleeding (bleeding related to poor graft function and coagulopathy, resulting in continuous oozing of blood) or noncoagulopathic bleeding (bleeding in patients with normal coagulation function).Computed tomography (CT) has been reported to be a sensitive modality for detecting active bleeding in patients with major trauma.

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Section: Discussionmentioning

confidence: 99%

Untitled

Hsieh

Chou²,

Lin³

et al. 2017

Exp Clin Transplant

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“…Indirect blood supply also originates from the gastroduodenal artery via its distal branches supplying the common bile duct (10). Hypoperfusion of the biliary blood supply can result in poor function or death of the cholangiocytes (11). Damage to the biliary epithelium will both decrease bile flow and also impair cholangiocyte fluid secretion, altering bile composition (12,13).…”

Section: A B a Bmentioning

confidence: 99%

Secondary sclerosing cholangitis in a critically ill patient

Weiss¹,

Willmann²,

Jeffrey³

et al. 2016

Quant. Imaging Med. Surg.

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“…Anastomotic strictures (AS) are mainly related to the surgical technique and to ischemia to the distal bile stump [104,105] . Non-AS (NAS) are thought to be caused by three different types of injuries: I/R, immune-mediated mechanisms, and cytotoxic injury from bile salts [106] . The highest incidence of NAS has been reported for DCD livers as they suffer from an additional warm ischemia time during organ retrieval [107] .…”

Section: Itblmentioning

confidence: 99%

Strategies to optimize the use of marginal donors in liver transplantation

Pezzati

Ghinolfi

Simone

et al. 2015

WJH

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Liver transplantation is the treatment of choice for end stage liver disease, but availability of liver grafts is still the main limitation to its wider use. Extended criteria donors (ECD) are considered not ideal for several reasons but their use has dramatically grown in the last decades in order to augment the donor liver pool. Due to improvement in surgical and medical strategies, results using grafts from these donors have become acceptable in terms of survival and complications; nevertheless a big debate still exists regarding their selection, discharge criteria and allocation policies. Many studies analyzed the use of these grafts from many points of view producing different or contradictory results so that accepted guidelines do not exist and the use of these grafts is still related to non-standardized policies changing from center to center. The aim of this review is to analyze every step of the donationtransplantation process emphasizing all those strategies, both clinical and experimental, that can optimize results using ECD.

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Ischemia-Reperfusion Injury and Ischemic-Type Biliary Lesions following Liver Transplantation

Cited by 87 publications

References 227 publications

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Untitled

Secondary sclerosing cholangitis in a critically ill patient

Strategies to optimize the use of marginal donors in liver transplantation

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