| Hepatic blood flow plays an important role in ischemic reperfusion injury. | |
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MedLine Citation:
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PMID: 21858913 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Severe IR injury is associated with poor hepatic micro-perfusion. The aim of the study is to investigate the role of hepatic artery flow (HAF) and portal vein flow (PVF) in IR injury. Materials and Methods: Between 01/04-06/08, 566 patients underwent orthotopic liver transplant (OLT). Data was retrospectively reviewed using the transplant database. Patients with HA or PV thrombosis and re-transplants were excluded. Intra-operative PVF and HAF and graft weights were measured routinely and central venous pressure (CVP), mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI), were recorded with hepatic blood flow measurement. Complete data was available in 311 primary OLT recipients (215M, 97F, age 54 10 years). Patient follow-up ranged from 215-1746 days (705 408). IR injury was defined by AST on POD 2 and patients divided into 3 groups, G1: mild IR injury AST>500 (n=160, 51%); G2: moderate, AST 500-1000 (n=85, 27%) and G3: severe, AST<1000 (n=66, 21%). Results: Demographics and pre-OLT variables: MELD score, platelets, PV thrombosis, TIPSS and the presence of shunts on CT scan were similar in all groups. Graft survival was 99% in G1 compared to 94% in G2 (p=.02) and 92% in G3 (p=.016). Patient survival was similar in all groups. CIT (min) was significantly higher in G 3 compared to G 1, p>.007. Hepatic hemodynamic data is outlined in Table 1. On statistical analysis low HAF, PVF, TLBF and Aug HAF were associated with a greater likelihood of elevated AST on POD 2. The strongest univariate predictors of AST were reduced augmented HAF/100g (p>0.001) and reduced TLBF/100g (p>0.001). On covariate analysis with adjustments for CIT and donor variables, blood flow parameters remained important predictors of graft function Conclusion: this report demonstrates for the first time that reduced hepatic blood flow is a significant finding in patients with severe hepatic IR injury. © 2011 American Association for the Study of Liver Diseases. |
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Authors:
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Dympna Kelly |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-8-19 |
Journal Detail:
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Title: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society Volume: - ISSN: 1527-6473 ISO Abbreviation: - Publication Date: 2011 Aug |
Date Detail:
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Created Date: 2011-8-22 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100909185 Medline TA: Liver Transpl Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2011 American Association for the Study of Liver Diseases. |
Affiliation:
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Department of General Surgery, A100, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195. kellyd@ccf.org. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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