Protective Effect of Retrograde Reperfusion Against Hepatic Autophagy Impairment in Rat Liver Transplantation

Cheng, Yuan; Lan, Haibin; Chen, Yongtai; Jiang, Yi; Chen, Yongbiao

doi:10.1016/j.transproceed.2020.10.010

Cited by 4 publications

(3 citation statements)

References 13 publications

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“…Autophagic activity is therefore a protective factor in alleviating IRI injury. Cheng's team pioneered the construction of a retrograde perfusion rat model and compared the effect of re ow mode on postoperative liver function by measuring the attenuation intensity of autophagic activity, and concluded that the duration of autophagic activity in RTR protects the function of healthy mitochondria [10] . RTR was pioneered by Kniepeiss's [5] team, and the inverse perfusion method showed irreplaceable advantages in reducing transaminases.…”

Section: Discussionmentioning

confidence: 99%

Effect of liver transplantation with retrograde reperfusion on early postoperative recovery of liver function and its risk factors

Shen,

Wang,

Yang

et al. 2023

Preprint

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Background The purpose of this study was to investigate effect of liver transplantation with retrograde reperfusion on early postoperative recovery of liver function and its risk factors. Methods The clinical data of 136 patients who underwent liver transplantation at the 900th Hospital of the Chinese People's Liberation Army Joint Support Army from January 2015 to January 2021 were retrospectively analyzed. There were 115 males and 21 females; the age of these patients ranged from 20 to 70 years, with a median age of 51 years. All patients signed an informed consent, in accordance with medical ethics regulations. The patients were divided into retrograde reperfusion (RTR) group (n=108) and initial portal reperfusion (IPR) group (n=28) according to different liver perfusion methods during transplantation. After the two groups were matched by propensity score of 1:1, 23 patients in the two groups were compared in the recovery of liver function after operation.Within the cohort of 114 patients under scrutiny, rigorous exclusions were applied to the RTR group. Specifically, 8 cases presenting initial hepatic artery unveiling after retrograde reperfusion, and 14 cases with simultaneous hepatic artery and portal vein unveiling post RTR, were omitted. Consequently, the study's focal analysis encompassed 86 cases in the RTR subset and 28 cases within the IPR subset. The patients in RTR group (n=86) were further divided into EAD group (n=19) and non-EAD group (n=67) according to whether early hepatic allograft dysfunction (EAD) occurred after operation. The effects of preoperative and intraoperative parameters and liver perfusion methods on EAD after liver transplantation were analyzed. Results Alanine aminotransferase (ALT) was 329 (211~548) and 176 (98~282) U/L on the 3rd and 7th day after RTR, respectively, which was significantly lower than 451 (288~918) and 251 (147~430) U/L in the IPR group (Z =-1.979, -2.299, P= 0.048, 0.021). Aspartate aminotransferase (AST) on postoperative days 3, 5, and 7 was 252 (193, 522), 105 (79, 163), and 93 (41, 135) U/L in the RTR group, respectively; it was also significantly lower than 328 (251, 724), 179 (129, 306), and 150 (91, 200)U/L in the IPR group (Z=-2.212, -3.221, -2.979; P=0.027, 0.001, 0.003). Logistic regression analysis showed that MELD score was an independent risk factor for EAD after liver transplantation. Conclusion RTR liver transplantation is more favorable for patients' early postoperative liver function recovery. For patients undergoing liver transplantation for RTR, preoperative MELD score was an independent risk factor for their postoperative development of EAD.

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Section: Discussionmentioning

confidence: 99%

Effect of liver transplantation with retrograde reperfusion on early postoperative recovery of liver function and its risk factors

Shen,

Wang,

Yang

et al. 2023

Preprint

Self Cite

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“…A técnica de revascularização retrógrada (RR) foi proposta em 2003, sendo uma técnica de reperfusão que proporciona refluxo de sangue lento e gradual para o enxerto 7 . O sangue pouco oxigenado da VCI atenua a carga pós-reperfusão de radicais livres de oxigênio e reduz os desequilíbrios microcirculatórios e eletrolíticos 8 .…”

Section: R E S U M O R E S U M Ounclassified

A reperfusão retrógrada combinada com a lavagem do enxerto pode ampliar a aceitabilidade de fígados limítrofes no transplante hepático? Resultados intraoperatórios e precoces de uma coorte prospectiva

CIRILO NETO,

MOUTINHO,

MELO

et al. 2023

Rev. Col. Bras. Cir.

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RESUMO Introdução: várias técnicas de reperfusão foram desenvolvidas a fim de reduzir o dano da lesão induzida por isquemia-reperfusão. Este estudo objetivou avaliar a reperfusão retrograda (RR) comparado com a reperfusão anterógrada (AR), com e sem a realização da técnica de lavagem do enxerto (WO). Métodos: coorte prospectiva com 94 transplantes ortotópicos de fígado de doador falecido divididos em três grupos: RR com WO (RR+WO), reperfusão anterógrada com WO (AR+WO), e AR sem WO (AR). Este estudo não designou a técnica de reperfusão entre os participantes. O desfecho primário considerou a disfunção precoce do enxerto, e os desfechos secundários incluíram a síndrome pós-reperfusão (SPR), lactato pós-reperfusão, balanço hídrico operatório, e uso de drogas vasoativas durante o ato peratório. Resultados: 87 pacientes foram submetidos para consolidação dos dados-29 no RR+WO, 27 no AR+WO, e 31 no AR. A prevalência de enxertos maginais não diferiu entre os grupos (34% vs 22% vs 23%; p=0,49). Disfunção precoce do enxerto ocorreu em uma proporção similar (24% vs 26% vs 19%; p=0,72). RR+WO reduziu o lactato sérico pós-reperfusão (p=0,034) e a incidência de SPR severa (17% vs 33% vs 55%; p=0,051), entretanto a infusão de noradrenalina >0,5mcg/kg/min não foi diferente durante a cirurgia (20,7% vs 29,6% vs 35,5%, p=0,45). Conclusões: o desfecho primário não diferiu significativamente entre os grupos; entretanto, o manejo hemodinâmico intra-operatório foi mais seguro no grupo RR+WO. Nós teorizamos que a técnica RR+WO pode reduzir a SPR e beneficiar enxertos marginais no transplante de fígado.

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“…The retrograde revascularization (RR) technique was proposed in 2003; it constitutes a reperfusion technique that provides low and gradual backflow of blood to the graft 7 . The low-oxygenated blood of IVC attenuates the post-reperfusion load of oxygen free radicals and reduces circulatory and electrolyte imbalances 8 .…”

Section: Introductionmentioning

confidence: 99%

Could retrograde reperfusion combined with washout technique broaden the applicability of marginal grafts in liver transplantation? Intra-operative and short-term outcomes of a prospective cohort

CIRILO NETO,

MOUTINHO,

MELO

et al. 2023

Rev. Col. Bras. Cir.

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Introduction: many revascularization techniques were designed to reduce the imbalance of ischemia-reperfusion injury. This study’s objective is to evaluate retrograde reperfusion (RR) compared to sequential anterograde reperfusion (AR), with and without the washout technique (WO). Method: this prospective cohort study collected data from 94 deceased donor orthotopic liver transplants and divided it into three groups: RR with WO (RR+WO), AP with WO (AR+WO), and AP without WO (AR). This study did not assign the reperfusion technique to the participants. The primary outcome considered the early graft dysfunction, and secondary outcomes included post-reperfusion syndrome (PRS), post-reperfusion lactate, surgery fluid balance, and vasoactive drug dose during the surgery. Results: 87 patients were submitted to the final analysis-29 in the RR+WO group, 27 in the AR+WO group, and 31 in the AR group. Marginal grafts prevalence was not significantly different between the groups (34% vs. 22% vs. 23%; p=0.49) and early graft dysfunction occurred at the same rate (24% vs. 26% vs. 19%; p=0.72). RR+WO reduced serum post-reperfusion lactate (p=0.034) and the incidence of significant PRS (17% vs. 33% vs. 55%; p=0.051), but norepinephrine dosing >0.5mcg/kg/min were not different during the surgery (20,7% vs. 29,6% vs. 35,5%, p=0.45). Conclusions: primary outcome was not significantly different between the groups; however, intraoperative hemodynamic management was safer using the RR+WO technique. We theorized that the RR+WO technique could reduce the incidence of PRS and benefit marginal graft survival following diseased donor orthotopic liver transplantation.

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Protective Effect of Retrograde Reperfusion Against Hepatic Autophagy Impairment in Rat Liver Transplantation

Cited by 4 publications

References 13 publications

Effect of liver transplantation with retrograde reperfusion on early postoperative recovery of liver function and its risk factors

Effect of liver transplantation with retrograde reperfusion on early postoperative recovery of liver function and its risk factors

A reperfusão retrógrada combinada com a lavagem do enxerto pode ampliar a aceitabilidade de fígados limítrofes no transplante hepático? Resultados intraoperatórios e precoces de uma coorte prospectiva

Could retrograde reperfusion combined with washout technique broaden the applicability of marginal grafts in liver transplantation? Intra-operative and short-term outcomes of a prospective cohort

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