Large-for-size liver transplantation: a flowmetry study in pigs

Moreira, Daniel de Albuquerque Rangel; Tannuri, Ana Cristina Aoun; Belon, Alessandro Rodrigo; Coelho, Maria Cecília Mendonça; Gonçalves, Josiane Oliveira; Serafini, Suellen; Lima, Fábio; Agostini, Luciana Orsi; Guimarães, Raimundo Renato; Tannuri, Uenis

doi:10.1016/j.jss.2014.03.018

Cited by 19 publications

(16 citation statements)

References 13 publications

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“…Avoiding elevated IAP is considered to be a critical element in the successful surgical management of pediatric liver transplant recipient care. Additionally, graft volume should be well‐matched to the recipient's abdomen size to prevent impairment of blood supply and graft dysfunction associated with abdominal compartment syndrome . Surgeons perform TAC with patch enlargement of the abdominal cavity when split adult‐liver grafts are too large to fit within the abdominal cavity of small patients without leading to pressurization of the organ .…”

Section: Discussionmentioning

confidence: 99%

“…A size mismatch between a small abdominal cavity and a relatively large split organ in small children can lead to traction and insufficient compliance of the abdominal wall, a circumstance that has the potential to produce high IAP. Impaired arterial and portal blood flow due to an elevated IAP can lead to graft dysfunction . Therefore, a TAC with a patch is often used to enlarge the abdominal cavity in small children receiving a liver transplant .…”

Section: Introductionmentioning

confidence: 99%

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Monitoring intra‐abdominal pressure after liver transplantation in children

Deindl

Wagner

Herden

et al. 2019

Pediatric Transplantation

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IAH after LTX can impair perfusion and threaten graft viability. This study aimed to assess the feasibility of longitudinal IAP measurements as an IAH screening method in children after LTX. A cohort of 23 children with a mean age (range) 3.1 (3 months–14 years) who underwent LTX between May 2017 and February 2018 were evaluated retrospectively. Longitudinal IAP measurements were compared to bedside Doppler US monitoring data. In total, 425 IAP measurements and 257 US examinations were performed. The mean ± SD (range) time expenditure for IAP measurement was 1.9 ± 0.4 (0.5‐3.2) minutes. The mean post‐operative IAP was 7.9 ± 3.6 (1‐25) mm Hg. IAH (IAP ≥ 10 mm Hg) was noted in 102 (24%) of 257 measurements. Agitation had a significant impact on IAP (estimate: 9.3 mm Hg, CI: 6.72‐11.97, P < .01). In patients with TAC, IAP was increased (6.7 ± 2.1 vs 8.7 ± 3.1 mm Hg, P = .02) while peak portal venous velocities decreased (38 ± 27 vs 26 ± 22 cm/s, P = .03) after patch reduction. An abdominal compartment syndrome with severely impaired vascular flow was noted in one patient. Episodes of elevated IAP were noted in a large proportion of patients, underscoring the need for IAP monitoring in pediatric liver transplant recipients. The safety and low time expenditure associated with IAP measurement could be included easily into standard nursing procedures for these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Monitoring intra‐abdominal pressure after liver transplantation in children

Deindl

Wagner

Herden

et al. 2019

Pediatric Transplantation

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“…The expression levels of the IEG, c‐Fos and c‐Jun, and the anti‐apoptotic Bcl‐xl , pro‐apoptotic Bax , eNOS, and IL‐6 genes were measured by real time RT‐PCR, similar to a previous experiment …”

Section: Methodsmentioning

confidence: 99%

Does a meso‐caval shunt have positive effects in a pig large‐for‐size liver transplantation model?

Tannuri

Moreira

Belon

et al. 2017

Pediatric Transplantation

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In pediatric liver transplantations with LFS grafts, higher incidences of graft dysfunction probably occur due to IRI. It was postulated that increasing the blood supply to the graft by means of a meso-caval shunt could ameliorate the IRI. Eleven pigs underwent liver transplantation and were divided into two groups: LFS and LFS+SHUNT group. A series of flowmetric, metabolic, histologic, and molecular studies were performed. No significant metabolic differences were observed between the groups. One hour after reperfusion, portal flow was significantly lower in the recipients than in the donors, proving that the graft was maintained in low portal blood flow, although the shunt could promote a transient increase in the portal blood flow and a decrease in the arterial flow. Finally, it was verified that the shunt promoted a decrease in inflammation and steatosis scores and a decrease in the expression of the eNOS gene (responsible for the generation of nitric oxide in the vascular endothelium) and an increase in the expression of the proapoptotic gene BAX. The meso-caval shunt was responsible for some positive effects, although other deleterious flowmetric and molecular alterations also occurred.

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“…A graft-to-recipient weight ratio greater than 4% (particularly for recipients weighing less than 10 kg) should raise suspicion for liver graft/abdominal cavity size discrepancy; while it increases the risk for IAH, vascular complications and ischemia-reperfusion injury [65,66]. Doppler ultrasonography should be performed upon fascia closure and followed closely thereafter, along with IAP monitoring.…”

Section: Liver Transplantationmentioning

confidence: 99%

Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis, hepato-pancreato-biliary operations and liver transplantation

Bressan

Ball

2017

Anaesthesiol Intensive Ther

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Intra-abdominal hypertension, even preceding the onset of abdominal compartment syndrome, is still recognized as an adverse prognostic factor. Unfortunately, most of the current supporting evidence within the critical care environment remains observational in nature. In acute pancreatitis, an active role for intra-abdominal hypertension early in the disease process follows a strong intuitive basis, and it is corroborated by preliminary evidence from animal models. Additional studies are needed to better characterize the optimal fluid resuscitation strategy, as well as the importance of intra-abdominal hypertension as an early therapeutic target. All critically ill patients with acute pancreatitis should be considered for routine intra-abdominal pressure monitoring. The prevalence and clinical relevance of intra-abdominal hypertension after elective major abdominal operations are underestimated in the literature. Hepato-pancreato-biliary surgery and liver transplantation represent high-risk surgical subspecialties, and routine intra-abdominal hypertension risk assessment to indicate postoperative intra-abdominal pressure monitoring can be recommended. Conservative management of intra-abdominal hypertension should be promptly initiated upon diagnosis. Although abdominal catheter drainage and decompressive laparotomy may be required in refractory cases based on expert clinical judgment, precise indications and timing are still unclear. Implementation of institutional protocols based on the Abdominal Compartment Society reference standards is crucial to optimize both clinical management and research in this evolving area.

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Large-for-size liver transplantation: a flowmetry study in pigs

Cited by 19 publications

References 13 publications

Monitoring intra‐abdominal pressure after liver transplantation in children

Monitoring intra‐abdominal pressure after liver transplantation in children

Does a meso‐caval shunt have positive effects in a pig large‐for‐size liver transplantation model?

Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis, hepato-pancreato-biliary operations and liver transplantation

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