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Wouters D, Blondeau M, Bos I, Camus C, Jezequel C, bardou‐Jacquet E, van der Plas WS, Nieuwenhuis LM, de Meijer VE, Porte RJ, Rayar M. Comparison of reconstruction methods used during liver transplantation in case of a graft with replaced or accessory right hepatic artery: a retrospective study. J Hepato Biliary Pancreat 2022. [DOI: 10.1002/jhbp.1268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Dune Wouters
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen University Medical Center Groningen Groningen The Netherlands
- Surgical Research Laboratory, University of Groningen University Medical Center Groningen Groningen the Netherlands
| | - Marc Blondeau
- CHU Rennes Service de Chirurgie Hépatobiliaire et Digestive Rennes France
| | - Isabel Bos
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen University Medical Center Groningen Groningen The Netherlands
- Surgical Research Laboratory, University of Groningen University Medical Center Groningen Groningen the Netherlands
| | - Christophe Camus
- CHU Rennes Service de Maladies Infectieuses et Réanimation Médicale Rennes France
| | | | - Edouard bardou‐Jacquet
- CHU Rennes, Service des maladies du foie Rennes France
- Univ Rennes, INSERM, INRAE, Institut NUMECAN (Nutrition Metabolisms and Cancer) Rennes France
| | - Willemijn S. van der Plas
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen University Medical Center Groningen Groningen The Netherlands
- Surgical Research Laboratory, University of Groningen University Medical Center Groningen Groningen the Netherlands
| | - Lianne M. Nieuwenhuis
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen University Medical Center Groningen Groningen The Netherlands
- Surgical Research Laboratory, University of Groningen University Medical Center Groningen Groningen the Netherlands
| | - Vincent E. de Meijer
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen University Medical Center Groningen Groningen The Netherlands
- Surgical Research Laboratory, University of Groningen University Medical Center Groningen Groningen the Netherlands
| | - Robert J. Porte
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen University Medical Center Groningen Groningen The Netherlands
- Surgical Research Laboratory, University of Groningen University Medical Center Groningen Groningen the Netherlands
| | - Michel Rayar
- CHU Rennes Service de Chirurgie Hépatobiliaire et Digestive Rennes France
- Univ Rennes, INSERM, INRAE, Institut NUMECAN (Nutrition Metabolisms and Cancer) Rennes France
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Brüggenwirth IMA, van der Plas WS, van Leeuwen OB, Thorne AM, Rayar M, de Meijer VE, Porte RJ. Oxygenated versus non-oxygenated flush out and storage of donor livers-An experimental study. Artif Organs 2021; 46:201-209. [PMID: 34866205 PMCID: PMC9299999 DOI: 10.1111/aor.14135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/18/2021] [Accepted: 10/20/2021] [Indexed: 11/28/2022]
Abstract
Background During donor organ procurement and subsequent static cold storage (SCS), hepatic adenosine triphosphate (ATP) levels are progressively depleted, which contributes to ischemia‐reperfusion injury (IRI). We sought to investigate a simple approach to prevent ATP depletion and IRI using a porcine donation after circulatory death (DCD) liver reperfusion model. Methods After 30 min warm ischemia, porcine livers were flushed via the portal vein with cold (4°C) non‐oxygenated University of Wisconsin (UW) preservation solution (n = 6, control group) or with oxygenated UW (n = 6, OxyFlush group). Livers were then subjected to 4 h SCS in non‐oxygenated (control) or oxygenated (OxyFlush) UW, followed by 4 h normothermic reperfusion using whole blood. Hepatic ATP levels were compared, and hepatobiliary function and injury were assessed. Results At the end of SCS, ATP was higher in the OxyFlush group compared to controls (delta ATP of +0.26 vs. −0.68 µmol/g protein, p = 0.04). All livers produced bile and metabolized lactate, and there were no differences between the groups. Grafts in the OxyFlush group had lower blood glucose levels after reperfusion (p = 0.04). Biliary pH, glucose and bicarbonate were not different between the groups. Injury markers including liver transaminases, lactate dehydrogenase, malondialdehyde, cell‐free DNA and flavin mononucleotide in the SCS solution and during reperfusion were also similar. Histological assessment of the parenchyma and bile ducts did not reveal differences between the groups. Conclusion Oxygenated flush out and storage of DCD porcine livers prevents ATP depletion during ischemia, but this does not seem sufficient to mitigate early signs of IRI.
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Affiliation(s)
- Isabel M A Brüggenwirth
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Willemijn S van der Plas
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Otto B van Leeuwen
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Adam M Thorne
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Michel Rayar
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands.,Centre Hospitalier Universitaire de Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France
| | - Vincent E de Meijer
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert J Porte
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
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Bos I, Blondeau M, Wouters D, Camus C, Houssel-Debry P, van der Plas WS, Nieuwenhuis LM, Bardou-Jacquet E, Lisman T, de Meijer VE, Porte RJ, Rayar M. Therapeutic anticoagulation after liver transplantation is not useful among patients with pre-transplant Yerdel-grade I/II portal vein thrombosis: A two-center retrospective study. J Thromb Haemost 2021; 19:2760-2771. [PMID: 34297481 DOI: 10.1111/jth.15472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is no longer a contraindication for liver transplantation (LT). While therapeutic anticoagulation (tAC) is recommended during the waiting period, there is no evidence for its usefulness in the prevention of PVT recurrence after LT. OBJECTIVES The aim of our study was to evaluate the role of tAC post-LT in the prevention of PVT recurrence. PATIENTS/METHODS All adult LTs performed in two high-volume centers between 2003 and 2018 were retrospectively analysed. Only patients with PVT classified as Yerdel grade I or II and with standard portal reconstruction were included. PVT recurrence and tAC-associated morbidity within 1 year were compared between patients receiving tAC or not. RESULTS During the study period, of 2612 LTs performed, 235 (9%) patients with PVT were included; 113 patients (48.1%) received post-LT tAC (tAC group) while 122 (51.9%) did not (non-tAC group). The incidence of bleeding events was significantly higher in the tAC group (26 [23%] vs. 5 [4.1%], P < .01) and the initial hospitalization duration was longer (21 vs. 17.5 days, P < .01). Within the first year, PVT recurrence was observed for 9 (3.8%) patients without any difference between the tAC and non-tAC groups (6 [5.1%] vs. 3 [2.5%], P = .39). The only identified risk factor for PVT recurrence was the recipients' age (odds ratio= 0.94, P = .03). Graft (P = .11) and patient (P = .44) survival were similar between the two groups. CONCLUSION Therapeutic anticoagulation is not necessary in the prevention of grade I/II PVT recurrence and is associated with higher morbidity and longer hospital stay.
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Affiliation(s)
- Isabel Bos
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Surgical Research Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marc Blondeau
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France
| | - Dune Wouters
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Surgical Research Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Christophe Camus
- Service de Maladies Infectieuses et Réanimation Médicale, CHU Rennes, Rennes, France
- INSERM, Rennes, France
| | | | - Willemijn S van der Plas
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Surgical Research Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Lianne M Nieuwenhuis
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Surgical Research Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Ton Lisman
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Surgical Research Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Vincent E de Meijer
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Surgical Research Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robert J Porte
- Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Surgical Research Laboratory, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Michel Rayar
- Service de Chirurgie Hépatobiliaire et Digestive, CHU Rennes, Rennes, France
- INSERM, Rennes, France
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