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Rodriguez IE, Asher ZP, Klingenberg K, Wright FL, Nydam TL, Adams MA, Bababekov YJ, Peltz E, Smith JW, Saben JL, Kennealey P, Pomposelli JJ, Pomfret EA, Moore HB. Phase I clinical trial of the feasibility and safety of direct peritoneal resuscitation in liver transplantation. Am J Surg 2024; 238:115815. [PMID: 39003094 PMCID: PMC11585457 DOI: 10.1016/j.amjsurg.2024.115815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Direct peritoneal resuscitation (DPR) is associated with improved outcomes in trauma. Animal models suggest DPR has favorable effects on the liver. We sought to evaluate its safety and assess for improved outcomes in liver transplantation (LT). METHODS LT patients with renal dysfunction and/or obesity were enrolled in a phase-I clinical trial. DPR lasted 8-24 h depending on postoperative disposition. Primary outcome was percent of patients completing DPR. Secondary outcomes evaluated complications. Controls with either obesity (control-1) or both risk factors (obesity + renal dysfunction, control-2) were analyzed. RESULTS Fifteen patients were enrolled (seven with both criteria and eight with obesity alone). DPR was completed in 87 % of patients, with one meeting stopping criteria. Controls included 45 (control-1) and 24 (control-2) patients. Return to operating room, graft loss, and late infections were lower with DPR. CONCLUSION DPR appears to be safe in closed abdomens following LT, warranting a follow-up phase-II trial to assess efficacy.
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Affiliation(s)
- Ivan E Rodriguez
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE), Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Zachary P Asher
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katherine Klingenberg
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE), Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Franklin L Wright
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Trevor L Nydam
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE), Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Megan A Adams
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE), Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Division of Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Yanik J Bababekov
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE), Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Eric Peltz
- Department of Surgery, Logan Health Medical Center, Kalispell, MT, USA
| | - Jason W Smith
- Department of Surgery, University of Louisville Health, Louisville, KY, USA
| | - Jessica L Saben
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE), Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Peter Kennealey
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE), Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - James J Pomposelli
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE), Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth A Pomfret
- Colorado Center for Transplantation Care, Research, and Education (CCTCARE), Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Hunter B Moore
- AdventHealth Transplant Institute at Porter, Denver, CO, USA.
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Gaspari R, Spinazzola G, Aceto P, Avolio AW, Delli Compagni M, Postorino S, Michi T, Fachechi DC, Modoni A, Antonelli M. Intensive Care Unit-Acquired Weakness after Liver Transplantation: Analysis of Seven Cases and a Literature Review. J Clin Med 2023; 12:7529. [PMID: 38137598 PMCID: PMC10743957 DOI: 10.3390/jcm12247529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
Intensive Care Unit (ICU)-Acquired Weakness (ICU-AW) is a generalized muscle weakness that is clinically detected in critical patients and has no plausible etiology other than critical illness. ICU-AW is uncommon in patients undergoing orthotopic liver transplantation (OLT). Our report sheds light on the highest number of ICU-AW cases observed in a single center on OLT patients with early allograft dysfunction. Out of 282 patients who underwent OLT from January 2015 to June 2023, 7 (2.5%) developed generalized muscle weakness in the ICU and underwent neurophysiological investigations. The neurologic examination showed preserved extraocular, flaccid quadriplegia with the absence of deep tendon reflexes in all patients. Neurophysiological studies, including electromyography and nerve conduction studies, showed abnormalities with fibrillation potentials and the rapid recruitment of small polyphasic motor units in the examined muscles, as well as a reduced amplitude of the compound muscle action potential and sensory nerve action potential, with an absence of demyelinating features. Pre-transplant clinical status was critical in all patients. During ICU stay, early allograft dysfunction, acute kidney injury, prolonged mechanical ventilation, sepsis, hyperglycemia, and high blood transfusions were observed in all patients. Two patients were retransplanted. Five patients were alive at 90 days; two patients died. In non-cooperative OLT patients, neurophysiological investigations are essential for the diagnosis of ICU-AW. In this setting, the high number of red blood cell transfusions is a potential risk factor for ICU-AW.
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Affiliation(s)
- Rita Gaspari
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.G.); (G.S.); (M.D.C.); (S.P.); (T.M.); (D.C.F.); (M.A.)
- Department of Basic Biotechnological Science, Intensive and Peri-Operative Clinics, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giorgia Spinazzola
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.G.); (G.S.); (M.D.C.); (S.P.); (T.M.); (D.C.F.); (M.A.)
| | - Paola Aceto
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.G.); (G.S.); (M.D.C.); (S.P.); (T.M.); (D.C.F.); (M.A.)
- Department of Basic Biotechnological Science, Intensive and Peri-Operative Clinics, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Alfonso Wolfango Avolio
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy;
- General Surgery and Liver Transplantation, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Manuel Delli Compagni
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.G.); (G.S.); (M.D.C.); (S.P.); (T.M.); (D.C.F.); (M.A.)
| | - Stefania Postorino
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.G.); (G.S.); (M.D.C.); (S.P.); (T.M.); (D.C.F.); (M.A.)
| | - Teresa Michi
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.G.); (G.S.); (M.D.C.); (S.P.); (T.M.); (D.C.F.); (M.A.)
| | - Daniele Cosimo Fachechi
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.G.); (G.S.); (M.D.C.); (S.P.); (T.M.); (D.C.F.); (M.A.)
| | - Anna Modoni
- Department of Geriatric, Neurologic, Orthopedics and Head-Neck Science, Area of Neuroscience, Institute of Neurology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Massimo Antonelli
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.G.); (G.S.); (M.D.C.); (S.P.); (T.M.); (D.C.F.); (M.A.)
- Department of Basic Biotechnological Science, Intensive and Peri-Operative Clinics, Catholic University of the Sacred Heart, 00168 Rome, Italy
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