Transplantation proceedings
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Our previous study demonstrated that Ligustrazine reduced renal dysfunction associated with ischemia-reperfusion injury in mice. In this study, we investigated whether Ligustrazine herbal injection had any preventive and therapeutic effectiveness against chronic allograft nephropathy in rats. ⋯ These findings suggested that Ligustrazine could postpone chronic renal allograft dysfunction associated with cold ischemia injury and chronic allograft rejection but had no evident hepatic side effects.
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Malignant hyperthermia is an autosomal dominant disorder with incomplete penetrance and variable expression. This syndrome is characterized by a hypermetabolic response to all commonly used inhalational anesthetics and depolarizing muscle relaxants. It can happen during or after the anesthesia. ⋯ Our patient was a 48-year-old man, born in Brazil but with European ascendance, who developed malignant hyperthermia associated with the use of isoflurane. He was treated with dantrolene, which caused hepatic graft dysfunction. It is important that transplant teams be able to recognize and treat this complication.
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Orthotopic liver transplantation (OLT) has historically been associated with massive blood loss and hemodynamic instability related to the coexistence of varices, coagulopathy, thrombocytopenia, and portal hypertension. Piggyback hepatectomy (PGB) is a technique increasingly utilized in OLT to avoid veno-venous bypass and vena cava clamping. This study evaluated the factors associated with blood loss and blood product requirement in PGB. ⋯ These results demonstrate that PGB can be safely accomplished in nearly all liver transplant patients without venovenous bypass or vena cava clamping and with less warm ischemia, which may ultimately be associated with less perioperative morbidity and improved outcomes.
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To report the morbidity and mortality of patients who undergo liver transplantation with or without T-tube implantation after choledochocholedochostomy as well as to discuss management of biliary complications. ⋯ This study showed choledochocholedochostomy with or without a T-tube after liver transplantation did not influence the biliary complications. The biliary complications of anastomotic stricture after liver transplantation can be managed by endoscopy with a stent. If endoscopy fails, surgical intervention should be considered immediately.
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A patient with alcohol induced end-stage liver disease developed cardiac arrest immediately after reperfusion during orthotopic liver transplantation. In our case, advanced age of the patient, alcohol-related severe liver disease with high ASA score, and myocardial dysfunction, combined with acute metabolic and hemodynamic changes throughout the surgery may have contributed to the development of postreperfusion syndrome resulting in cardiac arrest. ⋯ In conclusion, during severe postreperfusion syndrome, the collaboration between the surgical and anesthesia teams is crucial to overcome cardiac arrest. In an open abdomen, direct cardiac compressions through the transdiaphragmatic pericardial window instead of chest compressions were important to restore effective circulation during advanced life support.