Tissue oxygenation during liver transplantation

Steib, A.; Freys, G.; Gohard, R.; Curzola, U.; Ravanello, J.; Lutun, P.; Boudjéma, Karim; Otteni, J.-C.

doi:10.1097/00003246-199207000-00013

Cited by 24 publications

(26 citation statements)

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“…2,4,6,27,28 However, in our study, the number of blood units transfused, and therefore the decreases in 2,3-diphosphoglycerate, did not correlate with the P 50 values. On the other hand, according to our results, the decrease in P 50 values directly correlated to temperature decreases.…”

Section: Discussioncontrasting

confidence: 82%

“…27 We observed a rather weak and inconsistent relation of DO 2 ind with any of the other study parameters, including VO 2 ind . The release of vasoactive metabolites from the donor liver during reperfusion may influence the subsequent alterations of oxygen delivery and uptake.…”

Section: Discussioncontrasting

confidence: 54%

“…Severe intrapulmonary and extrapulmonary arterial-venous admixturing characterizes this group of patients, [23][24][25][26] and a rightward shift in the ODC is usually observed in patients with cirrhosis. 15,27 On the contrary, some of our patients had decreased P 50 values already before any intervention but after general anesthesia. Whether the hemodynamic and metabolic changes contributed to this decrease remains unknown.…”

Section: Discussionmentioning

confidence: 54%

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Oxygen availability during orthotopic liver transplantation

Kostopanagiotou

Smyrniotis

Theodoraki

et al. 2003

Liver Transplantation

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Studies have stressed the role of adequate tissue oxygenation in the light of an optimal patient outcome and allograft viability in liver transplantation. The practice of monitoring conventional hemodynamic parameters during liver transplantation could be complemented by parameters assessing real oxygen availability. In the present prospective study, real arterial available oxygen content (CavlO 2 ) and its extraction ratio (O 2 ERavl) were calculated. These parameters include the effect of changes in oxyhemoglobin dissociation curve (ODC; expressed by P 50 ) on oxygen availability, under the different circumstances occurring during liver transplantation. Sixteen adult cirrhotic patients were studied during orthotopic liver transplantation with the use of venovenous bypass. Classic hemodynamic measurements using a Swan-Ganz thermodilution catheter and arterial and mixed venous blood gas analysis were performed, and P 50 , oxygen deliv-

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Section: Discussioncontrasting

confidence: 82%

Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 54%

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Oxygen availability during orthotopic liver transplantation

Kostopanagiotou

Smyrniotis

Theodoraki

et al. 2003

Liver Transplantation

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“…An abnormal interdependence between oxygen consumption and oxygen delivery at clamping and unclamping has been reported in other studies, especially in hyperkinetic patients. 19 However, the influence of such a relationship on postoperative graft function and outcome remains unknown. 20 Similarly, hyperfibrinolysis caused by an imbalance between activators (tPA) and inhibitors (PAI), which tends to develop during the anhepatic phase, occurred in both groups, as shown by the dramatic shortening of euglobulin lysis time.…”

Section: Discussionmentioning

confidence: 99%

Orthotopic liver transplantation with preservation of portocaval flow compared with venovenous bypass

et al. 1997

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Conventional liver transplantation requires crossclamping of the hepatic pedicle and inferior vena cava, leading to severe hemodynamic and metabolic disturbances, usually attenuated by the use of venovenous bypass. A more recent surgical technique, piggyback with temporary portocaval shunting, preserves both caval and portal blood flows. The aim of this study was to compare the two methods prospectively. Forty-four patients with chronic liver disease were studied. Local anatomic conditions guided the surgeon to choose the easiest way to remove the native liver. Anesthetic management was standardized. Hemodynamic and metabolic changes were assessed by use of routine tests at specific periods. Graft function was evaluated by measurement of aminotransferases and monoethylglycinexylidide (MEGX) test 12, 24, 48, and 72 hours postoperatively. Conventional liver transplantation with venovenous bypass was performed in 26 patients, and the piggyback with temporary portocaval shunting was performed in 15 patients. ANOVA showed that cardiac output and systemic oxygen delivery were better maintained before revascularization in the piggyback group. Metabolic changes were comparable, and hyperfibrinolytic activity was detected in both groups. Graft function was comparable and satisfactory within the 3 first postoperative days. Piggyback with temporary portocaval shunting provided better intraoperative hemodynamics and tissue oxygenation than liver transplantation with venovenous bypass.

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“…2A) coincides with a decreased oxygen consumption reported by 0th-ers. 35,36 The relatively large decrease in glucose utilization after removal of the diseased liver is consistent with the finding that liver disease, paradoxically, impairs insulin-mediated glucose uptake by peripheral tissues such as skeletal muscle without compromising that by the liver itself.37 Poor peripheral uptake may partially explain why clinically significant hypoglycemia is not encountered during the anhepatic stage. The acutely decreased exogenous glucose uptake during the neohepatic stage ( Fig.…”

mentioning

confidence: 53%

Glucose and potassium metabolic responses to insulin during liver transplantation

Shangraw

Hexem

1996

Liver Transpl

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Insulin regulates glucose and potassium metabolism by acting differently upon peripheral tissues (e.g., skeletal muscle) and the splanchnic bed, including the liver. Liver disease is accompanied by "insulin resistance" of glucose metabolism, whereby glucose intolerance occurs despite relatively increased plasma insulin concentration. However, it is unknown whether insulin resistance extends to potassium metabolism. Further, it is uncertain whether the hyperglycemia and alterations of plasma potassium concentration observed during liver transplantation result from changes in circulating insulin concentration, altered sensitivity to insulin, or both, as the diseased liver is removed and replaced with a graft organ. The present study evaluated the role of the liver in maximal insulin responsiveness of whole-body glucose and potassium metabolism, using a hyperinsulinemic clamp technique, to identify the mechanism@) underlying post-reperfusion hyperglycemia and intraoperative hyperkalemia. Two protocols were employed: In protocol 1 (n = lo), no exogenous insulin was administered. In protocol 2 (n = lo), an intravenous insulin bolus (666 mU -kg-') was administered after anesthesia induction, followed by an infusion at 500 mU * m-*-min-l, which continued until 3 hours after portal vein unclamping. Plasma concentrations of glucose and potassium were regulated by glucose and potassium chloride infusion (euglycemic eukalemic clamp). Insulin-stimulated exogenous glucose and potassium uptakes were determined in protocol 2 before skin incision and during the dissection, anhepatic, and neohepatic stages. In both protocols, serial measurements of hemodynamic arterial blood gases, glucose, free fatty acids, potassium, insulin, and glucagon concentrations were made. Without insulin (protocol l), progressive hyperglycemia peaked after portal vein unclamping (postreperfusion hyperglycemia), with no concomitant decrease in plasma insulin concentration. Intraoperative plasma potassium concentration did not change. Insulin infusion (protocol 2) produced a stable hyperinsulinemia (-2000 pU/mL). Hyperinsulinemia did not eliminate post-reperfusion hyperglycemia. Insulin-stimulated glucose uptake, Copyright o 1996 by the American Association for the Study of Liver Diseases atients with liver disease are resistant to the P hypoglycemic action of insulin, which manifests as a spectrum from mild glucose intolerance to overt diabetes mellitus. 1-5 The disturbance of glucose metabolism is exacerbated during orthotopic liver transplantation (OLT) , during which hyperglycemia peaks after reperfusion of the graft liver (post-reperfusion hyperglycemia) and persists into the postoperative ~e t t i n g .~.~ Many patients require insulin therapy during and after OLT for control of plasma glucose concentration. It remains unclear, however, whether postreperfusion hyperglycemia stems from hypoinsulinemia, decreased peripheral sensitivity to insulin, or increased glucose output by the graft liver.

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Tissue oxygenation during liver transplantation

Cited by 24 publications

References 0 publications

Oxygen availability during orthotopic liver transplantation

Oxygen availability during orthotopic liver transplantation

Orthotopic liver transplantation with preservation of portocaval flow compared with venovenous bypass

Glucose and potassium metabolic responses to insulin during liver transplantation

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