Transplantation proceedings
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Hemorrhage is a common complication in the early postoperative period after orthotopic liver transplantation (OLT) and surgical reintervention may be necessary. We sought to assess the incidence as well as to identify potential risk factors for bleeding requiring surgical reintervention in the early postoperative period. From January 2003 to December 2005, we retrospectively reviewed the courses of 261 patients who underwent OLT. ⋯ In conclusion, early postoperative hemorrhage requiring urgent surgical reintervention is a severe complication with a high mortality. It is mainly caused by errors in surgical technique. Blood transfusion during transplantation was correlated with a higher mortality.
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A considerable percentage of hospital personnel are against organ donation, which at a crucial time could act as an obstacle to donation. Moreover, there is often a lack of training of personnel necessary for them to provide accurate information about organ donation and transplantation. Our objective was to determine the acceptability of a training course about organ donation among hospital workers in a center with an ongoing solid organ transplant program. ⋯ A training course about organ donation and transplantation might be useful given that only half of the workers would be prepared to take part and with respect to the target population, only 37% of them stating that they would participate. Its main use would be to reinforce the positive attitude of those who are already in favor and increase their knowledge about the subject. What is more, if these workers received adequate training they would serve to promote donation both directly and indirectly to the general public and other hospital personnel.
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The reperfusion period during liver transplantation is hemodynamically unstable. Accurate blood pressure measurements are the mainstay for the efficient management of abrupt cardiovascular changes. We sought to compare femoral arterial blood pressure (FABP) with radial arterial blood pressure (RABP) and noninvasive upper arm blood pressure (NIBP) in the reperfusion period. ⋯ We believe that NIBP in addition to RABP may be considered to be a reliable alternative when FABP is not available to evaluate hemodynamic instability in the reperfusion period during liver transplantation.
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Eighteen patients with hematologic malignancies underwent cord blood transplantation (CBT) from unrelated donors after being conditioned with myeloablative or reduced-intensity regimens, and received tacrolimus and methotrexate (15 mg/m(2) on day 1, 10 mg/m(2) on days 3 and 6) as graft-versus-host disease (GVHD) prophylaxis. The median number of nucleated cells in infused cord blood was 2.66 x 10(7)/kg (range 1.90 to 4.15 x 10(7)/kg). Engraftment was achieved in 16 of 18 patients. ⋯ Of the 18 patients, 14 were alive and disease-free between 173 and 1514 days after CBT (median 746 days). The probability of disease-free survival at 2 years was 79.1%. These results, although in a retrospective study, suggested that tacrolimus and short-term methotrexate effectively prevented the occurrence of severe acute GVHD after unrelated CBT, and may contribute to a high survival rate.
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The main metabolic pathway for defluorination of sevoflurane in the liver produces inorganic fluoride (Fl). The metabolism and effect of sevoflurane on the kidney is not clear during anhepatic phase in liver transplantation. The goal of the present study was to investigate the metabolism and renal effect of sevoflurane by measuring plasma and urine inorganic fluoride, urinary N-acetyl-glucosaminidase (NAG), and plasma creatinine levels in patients undergoing liver transplantations. ⋯ Sevoflurane seemed to have minimal effect on kidney functions of BUN and Cr levels during liver transplantation. Although urine F1 and NAG levels increased during the anhepatic phase plasma F1, BUN, and Cr levels did not, suggesting that renal F1 production may occur in the absence of hepatic function. The renal effect of sevoflurane in chronic liver disease is controversial and must be investigated in further studies.