Transplantation proceedings
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Prolonged corrected QT (QT(c)) interval and vagal dysfunction are common occurrences in liver cirrhosis and are determinants of mortality in patients with chronic liver disease. We evaluated whether propranolol can affect the relationship between QT(c) interval and cardiac vagal control of heart rate variability (HRV) in cirrhotic patients awaiting liver transplantation. ⋯ The prolonged QT(c) interval observed in cirrhotic patients may be reduced by propranolol administration, an effect attributable to improved vagal cardiac modulation. These findings suggest that propranolol may have a beneficial effect on perioperative mortality in cirrhotic patients awaiting liver transplantation.
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This study analyzed hemodynamic recordings collected on a beat-to-beat basis during orthotopic liver transplantation (OLT). The first aim was to construct a graphic that will represent hemodynamic profile during OLT. The second aim was to compare the intraoperative hemodynamic pattern of survivors versus nonsurvivors and those who received a liver from normal versus marginal donors. ⋯ This study shows changes in the hemodynamic profile during OLT, measured on a beat-to-beat basis. Intraoperative hemodynamic changes did not predict patients who did not survive OLT. Beat-to-beat monitoring did not reveal significant hemodynamic instability following transplantation of marginal grafts.
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Cardiac dysfunction in patients with cirrhosis and potential clinical implications have long been known, but the pathophysiology and potential targets for therapeutic intervention are still under investigation and are only now becoming understood. The pathophysiological changes result in systolic dysfunction, diastolic dysfunction, and electrophysiological changes. Here, we aim to review cirrhotic cardiomyopathy from a cellular and physiological model and how these patients develop overt heart failure in the setting of stress, such as infection, ascites, and procedures including transjugular intrahepatic portosystemic shunt, portocaval shunts, and orthotopic liver transplantation. We will also review the most current, although limited, available therapeutic modalities.
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Although stroke volume variation (SVV) is a valuable index of preload responsiveness, there is limited information about the association between low SVV and increased hepatectomy-related bleeding. We therefore evaluated whether SVV predicts blood loss during living donor hepatectomy. ⋯ SVV is a significant independent predictor of blood loss ≥ 700 mL during donor hepatectomy, suggesting that low SVV may provide useful information on intraoperative bleeding in donors undergoing right hepatectomy.
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To evaluate the awareness and attitudes of health care professionals toward organ/tissue donation and transplantation. ⋯ In conclusion, targeting health care professionals in the first place and development of nationwide media and educational campaigns on the ethical, moral, as well as religious dimensions of transplantation and donation seem crucial to increase the number of individuals who can act as role models via their positive impact on the general public's attitudes toward organ donation.