The effect of methylene blue during orthotopic liver transplantation on post reperfusion syndrome and postoperative graft function

Fukazawa, Kyota; Pretto, Ernesto A.

doi:10.1007/s00534-010-0344-7

Cited by 27 publications

(25 citation statements)

References 39 publications

(66 reference statements)

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“…We rarely use this technique in adult patients at our center because it is time‐consuming and may cause damage to RBCs during the centrifugation process. Many methods, including modified reperfusion techniques, small vasopressor boluses, and adequate volumes before reperfusion, can be used to prevent or treat PRS …”

Section: Discussionmentioning

confidence: 99%

Perioperative complications in liver transplantation using donation after cardiac death grafts: A propensity-matched study

et al. 2014

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Donation after cardiac death (DCD) is an important source for expanding the donor pool for liver transplantation (LT).Although the long-term outcomes of LT using DCD grafts have been extensively studied, perioperative complications related to DCD grafts are rarely reported. The aim of this study was to determine whether DCD grafts were associated with a higher incidence of postreperfusion complications and worse outcomes in adult LT patients. After institutional review board approval, the medical records of all adult patients who underwent LT at our medical center between 2004 and 2011 were reviewed. Postreperfusion complications and posttransplant outcomes were compared between patients receiving DCD grafts and patients receiving donation after brain death (DBD) grafts. In all, 74 patients received DCD grafts during the study period, and 1369 patients received DBD grafts. An initial comparison showed that many preoperative, prereperfusion, and donor variables in the DCD group differed significantly from those in the DBD group. Propensity matching was chosen so that adjustments could be made for the differences. A postmatching analysis showed that the preoperative, prereperfusion, and donor variables no longer differed between the 2 groups. The postreperfusion requirements for blood products and vasopressors, the posttransplant ventilation times, the incidence of posttransplant acute renal injury, and the 30-day and 1-year patient and graft survival rates were comparable between the 2 groups. However, patients receiving DCD grafts experienced significantly higher rates of hyperkalemia (33.8% versus 18.9%, P < 0.05) and postreperfusion syndrome (PRS; 25.7% versus 12.3%, P < 0.05). In conclusion, after adjustments for preoperative and prereperfusion risks via propensity matching, DCD grafts remained a risk factor for postreperfusion hyperkalemia and PRS. A prophylactic regimen aimed at decreasing postreperfusion hyperkalemia and PRS is recommended for the management of LT using DCD grafts. Liver The demand for organs for liver transplantation (LT) continues to exceed the supply. The discrepancy between the number of available organs and the number of patients waiting for transplantation remains significant. 1 To address this urgent shortage and the rising wait-list mortality rate, the expansion of the donor pool through the use of donation after cardiac death (DCD) grafts has been promoted. 2 Although donation after brain death (DBD) remains the predominant source of deceased donor grafts, the use of DCD grafts in LT is being increasingly accepted worldwide. Now LT using DCD grafts accounts for approximately 5% of all Abbreviations: ARI, acute renal injury; BMI, body mass index; CIT, cold ischemia time; DBD, donation after brain death; DCD, donation after cardiac death; DWIT, donor warm ischemia time; FFP, fresh frozen plasma; GWIT, graft warm ischemia time; ICU, intensive care unit; LT, liver transplantation; MELD, Model for End-Stage Liver Disease; PRS, postreperfusion syndrome; RBC, red blood cell; UCLA, Univer...

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Section: Discussionmentioning

confidence: 99%

Perioperative complications in liver transplantation using donation after cardiac death grafts: A propensity-matched study

et al. 2014

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“…During the pre‐anhepatic stage, the serum potassium level was maintained below 4.0 mEq/L with the intravenous administration of glucose (12.5‐25.0 g) and insulin (5‐10 U) and/or lasix (10‐40 mg). Before the reperfusion of the liver graft, the intravenous administration of sodium bicarbonate (50 mEq), calcium chloride (1000 mg), and methylene blue (100 mg) was performed . The inspiratory oxygen fraction was set at 1.0 before reperfusion.…”

Section: Methodsmentioning

confidence: 99%

Cardiac arrest during adult liver transplantation: A single institution's experience with 1238 deceased donor transplants

et al. 2013

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Liver transplantation (LT) is one of the highest risk noncardiac surgeries. We reviewed the incidence, etiologies, and outcomes of intraoperative cardiac arrest (ICA) during LT. Adult cadaveric LT recipients from January 1, 2001 through December 31, 2009 were reviewed. ICA was defined as an event requiring either closed chest compression or open cardiac massage. Cardiac arrest patients who recovered with only pharmacological interventions were excluded. Data included etiologies and outcomes of ICA, intraoperative deaths (IDs) and hospital deaths (HDs), and potential ICA risk factors. ICA occurred in 68 of 1238 LT recipients (5.5%). It occurred most frequently during the neohepatic phase (60 cases or 90%), and 39 of these cases (65.0%) experienced ICA within 5 minutes after graft reperfusion. The causes of ICA included postreperfusion syndrome (PRS; 26 cases or 38.2%) and pulmonary thromboembolism (PTE; 24 cases or 35.3%). A higher Model for End-Stage Liver Disease (MELD) score was found to be the most significant risk factor for ICA. The ID rate after ICA was 29.4% (20 cases), and the HD rate was 50.0% (34 cases). The 30-day patient survival rate after ICA was 55.9%, and the 1-year survival rate was 45.6%: these rates were significantly lower (P < 0.001) than those for non-ICA patients (97.4% and 85.1%, respectively). In conclusion, the incidence of ICA in adult cadaveric LT was 5.5% with an intraoperative mortality rate of 29.4%. ICA most frequently occurred within 5 minutes after reperfusion and resulted mainly from PRS and PTE. A higher MELD score was identified as a risk factor.

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“…Most recently, the incidence of PRS has been reported to be approximately 50% . One of the proposed causes of PRS is an increased production of NO . Other potential causes include the response to the release of inflammatory cytokines, particularly tumor necrosis factor α (TNF‐α), from the liver graft, which is known to activate the production of cGMP …”

Section: Discussionmentioning

confidence: 99%

Association between plasma cyclic guanosine monophosphate levels and hemodynamic instability during liver transplantation

et al. 2013

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The activation of cyclic guanosine monophosphate (cGMP) production in patients with end-stage liver disease (ESLD) has been associated with hemodynamic instability during orthotopic liver transplantation (OLT). The aim of this prospective, observational study was to investigate the involvement of cGMP in the mediation of profound hypotension during liver graft reperfusion. An additional objective was to determine whether preoperative cGMP levels are associated with intraoperative hemodynamic instability. Forty-four consecutive patients undergoing OLT were included in the study. Blood samples for cGMP analysis were obtained from (1) the radial artery before the surgical incision; (2) the radial artery, portal vein, and flush blood during the anhepatic phase; and (3) the radial artery 20 minutes after liver graft reperfusion. On the basis of a statistical analysis, the patients were divided into 2 groups: group 1 (preoperative cGMP level ! 0.05 lmol/L) and group 2 (preoperative cGMP level < 0.05 lmol/L). We demonstrated a significant correlation between the preoperative levels of cGMP and the amount of catecholamine required to maintain hemodynamic stability during reperfusion (r ¼ 0.52, P < 0.001), the length of the hospital stay (r ¼ 0.38, P ¼ 0.01), and the length of the intensive care unit (ICU) stay (r ¼ 0.44, P ¼ 0.004). We also demonstrated a significantly higher intraoperative catecholamine requirement (P < 0.001) and a prolonged postoperative ICU stay (P ¼ 0.02) in group 1 patients versus group 2 patients. In conclusion, this study demonstrates increased baseline cGMP production in patients with ESLD, which is significantly associated with severe hypotension during OLT. We suggest that preoperative levels of cGMP correlate with hemodynamic instability during liver graft reperfusion. Liver Transpl 19:191-198, 2013. V C 2012 AASLD.Received July 23, 2012; accepted October 23, 2012.Hemodynamic instability during orthotopic liver transplantation (OLT) is a poorly understood clinical problem. In particular, profound hypotension and significant arrhythmias during liver graft reperfusion are frequent events despite careful volume and electrolyte adjustments. The management of this hemodynamic instability can be especially challenging because of its refractory nature when standard vasoactive agents are used. As a result, only after a comprehensive preoperative evaluation can a medically optimized patient (ie, a patient in stable condition with a favorable short-and long-term cardiac prognosis) be accepted

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The effect of methylene blue during orthotopic liver transplantation on post reperfusion syndrome and postoperative graft function

Cited by 27 publications

References 39 publications

Perioperative complications in liver transplantation using donation after cardiac death grafts: A propensity-matched study

Perioperative complications in liver transplantation using donation after cardiac death grafts: A propensity-matched study

Cardiac arrest during adult liver transplantation: A single institution's experience with 1238 deceased donor transplants

Association between plasma cyclic guanosine monophosphate levels and hemodynamic instability during liver transplantation

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