The Minimal Flush Volume for Washout of Preservation Fluid in Liver Transplantation

Homvises, Boonlawat; Sirivatanauksorn, Yongyut; Limsrichamrern, Somchai; Pongraweewan, Orawan; Sujirattanawimol, Kittipong; Raksakietisak, Manee

doi:10.1016/j.transproceed.2008.06.035

Cited by 20 publications

(16 citation statements)

References 4 publications

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“…In the first category, laboratory parameters were tested, in which case transaminases and bilirubin were usually used to determine differences in graft damage and function . According to the potential benefit of various graft rinse protocols in preventing PRS, hemodynamic parameters were classified as the second common category , and the third category focused on graft function and survival data . Given the rather low evidence levels and the absence of appropriately designed RCT on the topic, the findings of the literature review failed to indicate which graft rinse protocol provides the best graft quality.…”

Section: Discussionmentioning

confidence: 99%

“…Two reports focused on other aspects of graft rinse in LT. In 2008, Homvises reported on a trial to determine the minimum flush volume of albumin to prevent PRS due to hyperkalemia . Their measurements in eleven patients revealed that portal vein flush with 500 milliliters of 5% albumin solution washed out more than 90% of the potassium load in the graft.…”

Section: Discussionmentioning

confidence: 99%

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Graft rinse prior to reperfusion in liver transplantation: literature review and online survey within the Eurotransplant community

et al. 2015

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SummaryGraft rinse prior reperfusion in liver transplantation (LT) is believed to reduce the incidence of postreperfusion syndrome and improve clinical outcome. A MEDLINE search was performed to obtain a comprehensive review of the published literature dealing with graft rinse in LT. Moreover, all thirty-four LT centers in the Eurotransplant (ET) region were invited to participate in an online survey to whether or not graft rinse is performed and whether further research in the field is needed. Seventeen reports have been found to investigate graft rinse protocols in 1894 LT recipients. Eighteen of the thirty centers that participated in the online survey performed graft rinse prior reperfusion in LT. The most commonly used rinse solution was albumin. Nineteen centers stated interest in participating in a multicenter RCT in the field. The published literature does not provide concluding appraisal of the benefit of graft rinse in LT. Graft rinse protocols are not standardized and are based on personal experience. Appropriately designed clinical trials addressing the topic are demanded. The online survey appears to be a helpful tool for the evaluation of clinical practice and future research topics in the transplant community.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Graft rinse prior to reperfusion in liver transplantation: literature review and online survey within the Eurotransplant community

et al. 2015

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“…Because the hepatic nerve of the transplant donor liver is transected at organ retrieval, the portal flow in the donor liver graft used for PF is directly associated with the volume status of the recipient . A recent report has shown that a minimum of 500 mL is required to remove enough preservation solution to avoid post‐reperfusion hyperkalemia, although size mismatch between donor and recipient was not taken into account . Acute hemorrhage associated with PF causes a rapid and large decrease in volume, which occurs immediately before reperfusion, may be attributed to post‐reperfusion cardiac arrest and may aggregate ischemia‐reperfusion injury by hypoperfusion of the liver graft, which may contribute to the higher incidence of PNF and low graft survival.…”

Section: Discussionmentioning

confidence: 99%

Crystalloid flush with backward unclamping may decrease post‐reperfusion cardiac arrest and improve short‐term graft function when compared to portal blood flush with forward unclamping during liver transplantation

Fukazawa

Nishida

Hibi

et al. 2013

Clinical Transplantation

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During liver transplant (LT), the release of vasoactive substances into the systemic circulation is associated with severe hemodynamic instability that is injurious to the recipient and/or the post-ischemic graft. Crystalloid flush with backward unclamping (CB) and portal blood flush with forward unclamping (PF) are two reperfusion methods to reduce reperfusion-related cardiovascular perturbations in our center. The primary aim of this study was to compare these two methods. After institutional review board (IRB) approval, cadaveric whole LT cases performed between 2003 and 2008 were reviewed. Patients were divided into two groups based on reperfusion methods: CB or PF. After background matching with propensity score, the effect of each method on post-operative graft function was assessed in detail. In our cohort of 478 patients, CB was used in 313 grafts and PF in 165. Thirty-day graft survival was lower, and risk of retransplantation was higher in PF. Multivariable model showed that CB is an independent factor to reduce primary non-function, cardiac arrest and improve 30-d graft survival. Also, the incidence of ischemic-type biliary lesions was significantly higher in the PF group. Reperfusion methods affect intraoperative hemodynamics and post-transplant outcome. CB allows for control over temperature and composition of the perfusate, perfusion pressure, and the rate of infusion.

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“…Treatments are administration of insulinglucose and/or salbutamol, furosemide, washing of bank blood using cell-salvage equipment, and hemodiafiltration. The effectiveness of different volumes of 5% albumin solution for the washout of preservation fluid in liver transplant grafts prior to reperfusion was measured; proposing the minimal washout fluid volume as 500 ml to reduce the risk of postreperfusion syndrome and hyperkalemia (Homvises et al, 2008). During neohepatic period baseline hypokalemia, low body weight (pediatric patients), administration of freshfrozen plasma units and absence of ascites at surgery were independent predictors for hypokalemia (Xia et al, 2006).…”

Section: Sodium Potassium and Glucose Management In Organ Transplantmentioning

confidence: 99%

Anesthesia in Liver Transplantation

Kanbak¹,

Karagöz²,

Üzümcügil³

2012

Liver Transplantation - Basic Issues

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The Minimal Flush Volume for Washout of Preservation Fluid in Liver Transplantation

Cited by 20 publications

References 4 publications

Graft rinse prior to reperfusion in liver transplantation: literature review and online survey within the Eurotransplant community

Graft rinse prior to reperfusion in liver transplantation: literature review and online survey within the Eurotransplant community

Crystalloid flush with backward unclamping may decrease post‐reperfusion cardiac arrest and improve short‐term graft function when compared to portal blood flush with forward unclamping during liver transplantation

Anesthesia in Liver Transplantation

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