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Rojas-Holguín A, Fondevila-Campo C, Sanjuanbenito A, Fabregat-Prous J, Secanella-Medayo L, Rotellar-Sastre F, Pardo-Sánchez F, Prieto-Calvo M, Marín-Ortega H, Sánchez-Cabús S, Diez-Valladares L, Alonso-Casado Ó, González-Serrano C, Rodríguez-Sanjuan JC, García-Plaza G, Jaén-Torrejimeno I, Suárez-Muñoz MÁ, Becerra-Massare A, Rio PSD, Pando E, López-Andújar R, Muñoz-Forner E, Rodriguez-López M, Pereira F, Serrablo-Requejo A, Turrión VS, Garrido MJ, Burdío F, Martín-Pérez E, Estevan-Estevan R, López-Guerra D, Castell-Gómez J, Salinas-Gómez J, López-Baena JÁ, López-Ben S, Solar-García L, Pérez-Alonso AJ, Martínez-Insfran LA, Blas JL, Cornejo M, Gutierrez-Calvo A, Pozo CDD, Ochando-Cerdan F, Muñoz-Bellvís L, Rebollar-Saenz J, Sánchez B, Jover JM, Gómez-Bravo MÁ, Ramia JM, Blanco-Fernández G. Repeated pancreatic resection for pancreatic metastases from renal cell Carcinoma: A Spanish multicenter study (PANMEKID). Surg Oncol 2024; 52:102039. [PMID: 38301449 DOI: 10.1016/j.suronc.2024.102039] [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: 12/12/2023] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND AND OBJECTIVES Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease-free survival. METHODS Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected. RESULTS The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2-56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895). CONCLUSION Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection.
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Affiliation(s)
- Adela Rojas-Holguín
- Universidad de Extremadura, Departamento de Terapeútica Médico Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Badajoz, Spain; Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Constantino Fondevila-Campo
- Department of Surgery, Hospital Clinic, Barcelona, Spain; Department of Surgery, Hospital Universitario La Paz, Madrid, Spain
| | | | - Joan Fabregat-Prous
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Luís Secanella-Medayo
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | | | - Héctor Marín-Ortega
- Department of Surgery, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | | | | | | | | | - Gabriel García-Plaza
- Department of Surgery, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Isabel Jaén-Torrejimeno
- Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Elizabeth Pando
- Department of Hepato-pancreato-biliary and Transplant Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rafael López-Andújar
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; Hepatology, HBP Surgery and Transplants, IIS La Fe, Hospital La Fe, Valencia, Spain
| | - Elena Muñoz-Forner
- Department of Surgery, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Mario Rodriguez-López
- Department of Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Fernando Pereira
- Department of Surgery, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | | | - Víctor Sánchez Turrión
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Manuel Jiménez Garrido
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Diego López-Guerra
- Universidad de Extremadura, Departamento de Terapeútica Médico Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Badajoz, Spain; Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Santiago López-Ben
- Department of Surgery, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Lorena Solar-García
- Department of Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Alejandro J Pérez-Alonso
- Department of Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain; Department of Surgery, Complejo Hospitalario de Jaén, Jaén, Spain
| | | | - Juan Luis Blas
- Department of Surgery, Hospital Royo Villanova, Zaragoza, Spain
| | - Marian Cornejo
- Department of Surgery, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | - Alberto Gutierrez-Calvo
- Department of Surgery Hospital Universitario Principe de Asturias. Alcalá de Henares, Madrid, Spain
| | | | | | - Luis Muñoz-Bellvís
- Department of Surgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Belinda Sánchez
- Department of Surgery, Hospital Regional de Málaga, Málaga, Spain
| | - José María Jover
- Department of Surgery, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - José M Ramia
- Hepatology, HBP Surgery and Transplants, IIS La Fe, Hospital La Fe, Valencia, Spain; Department of Surgery, Hospital General Universitario de Alicante, Alicante, Spain
| | - Gerardo Blanco-Fernández
- Universidad de Extremadura, Departamento de Terapeútica Médico Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Badajoz, Spain; Department of HBP Surgery and Liver Transplantation, Hospital Universitario de Badajoz, Badajoz, Spain.
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2
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Blanco-Fernández G, Fondevila-Campo C, Sanjuanbenito A, Fabregat-Prous J, Secanella-Medayo L, Rotellar-Sastre F, Pardo-Sánchez F, Prieto-Calvo M, Marín-Ortega H, Sánchez-Cabús S, Diez-Valladares L, Alonso-Casado Ó, González-Serrano C, Rodríguez-Sanjuan JC, García-Plaza G, Jaén-Torrejimeno I, Suárez-Muñoz MÁ, Becerra-Massare A, Rio PSD, Pando E, López-Andújar R, Muñoz-Forner E, Rodriguez-López M, Pereira F, Serrablo-Requejo A, Turrión VS, Garrido MJ, Burdío F, Martín-Pérez E, Estevan-Estevan R, López-Guerra D, Castell-Gómez J, Salinas-Gómez J, López-Baena JÁ, López-Ben S, Solar-García L, Pérez-Alonso AJ, Martínez-Insfran LA, Blas JL, Cornejo M, Gutierrez-Calvo A, Pozo CDD, Ochando-Cerdan F, Muñoz-Bellvís L, Rebollar-Saenz J, Sánchez B, Jover JM, Gómez-Bravo MÁ, Ramia JM, Rojas-Holguín A. Pancreatic metastases from renal cell carcinoma. Postoperative outcome after surgical treatment in a Spanish multicenter study (PANMEKID). Eur J Surg Oncol 2022; 48:133-141. [PMID: 34417061 DOI: 10.1016/j.ejso.2021.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 06/01/2021] [Revised: 07/17/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Renal Cell Carcinoma (RCC) occasionally spreads to the pancreas. The purpose of our study is to evaluate the short and long-term results of a multicenter series in order to determine the effect of surgical treatment on the prognosis of these patients. METHODS Multicenter retrospective study of patients undergoing surgery for RCC pancreatic metastases, from January 2010 to May 2020. Variables related to the primary tumor, demographics, clinical characteristics of metastasis, location in the pancreas, type of pancreatic resection performed and data on short and long-term evolution after pancreatic resection were collected. RESULTS The study included 116 patients. The mean time between nephrectomy and pancreatic metastases' resection was 87.35 months (ICR: 1.51-332.55). Distal pancreatectomy was the most performed technique employed (50 %). Postoperative morbidity was observed in 60.9 % of cases (Clavien-Dindo greater than IIIa in 14 %). The median follow-up time was 43 months (13-78). Overall survival (OS) rates at 1, 3, and 5 years were 96 %, 88 %, and 83 %, respectively. The disease-free survival (DFS) rate at 1, 3, and 5 years was 73 %, 49 %, and 35 %, respectively. Significant prognostic factors of relapse were a disease free interval of less than 10 years (2.05 [1.13-3.72], p 0.02) and a history of previous extrapancreatic metastasis (2.44 [1.22-4.86], p 0.01). CONCLUSIONS Pancreatic resection if metastatic RCC is found in the pancreas is warranted to achieve higher overall survival and disease-free survival, even if extrapancreatic metastases were previously removed. The existence of intrapancreatic multifocal compromise does not always warrant the performance of a total pancreatectomy in order to improve survival.
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Affiliation(s)
- Gerardo Blanco-Fernández
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Badajoz, Spain.
| | | | | | - Joan Fabregat-Prous
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Luís Secanella-Medayo
- Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | | | | | | | | | | | | | | | | | | | - Gabriel García-Plaza
- Department of Surgery, Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Isabel Jaén-Torrejimeno
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Elizabeth Pando
- Department of Hepato-pancreato-biliary and Transplant Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rafael López-Andújar
- Department of Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Elena Muñoz-Forner
- Department of Surgery, Hospital Clínico Universitariode Valencia, Valencia, Spain
| | - Mario Rodriguez-López
- Department of Surgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Fernando Pereira
- Department of Surgery, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | | | - Víctor Sánchez Turrión
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Manuel Jiménez Garrido
- Department of Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Elena Martín-Pérez
- Department of Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Diego López-Guerra
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Badajoz, Spain
| | | | | | | | - Santiago López-Ben
- Department of Surgery, Hospital Universitari Dr Josep Trueta, Girona, Spain
| | - Lorena Solar-García
- Department of Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Juan Luis Blas
- Department of Surgery, Hospital Royo Villanova, Zaragoza, Spain
| | - Marian Cornejo
- Department of Surgery, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | - Alberto Gutierrez-Calvo
- Department of Surgery Hospital Universitario Principe de Asturias. Alcalá de Henares, Madrid, Spain
| | | | | | - Luis Muñoz-Bellvís
- Department of Surgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Belinda Sánchez
- Department of Surgery, Hospital Regional de Málaga, Málaga, Spain
| | - José María Jover
- Department of Surgery, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - José M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Alicante, Spain
| | - Adela Rojas-Holguín
- Department of HBP and Liver Transplant Surgery, Hospital Universitario de Badajoz, Badajoz, Spain
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3
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de la Villa S, Valerio M, Salcedo M, Ortiz-Bautista C, Catalán P, Padilla B, Romero M, Blázquez-Bermejo Z, Pedraz Á, López-Baena JÁ, Hortal J, Bouza E, Alonso R, Muñoz P. Heart and liver transplant recipients from donor with positive SARS-CoV-2 RT-PCR at time of transplantation. Transpl Infect Dis 2021; 23:e13664. [PMID: 34092025 PMCID: PMC8209935 DOI: 10.1111/tid.13664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sofía de la Villa
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maricela Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Magdalena Salcedo
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,Servicio de Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Ortiz-Bautista
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Catalán
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Belén Padilla
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mario Romero
- Servicio de Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Álvaro Pedraz
- Servicio de Cirugía Cardiaca, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Ángel López-Baena
- Servicio de Cirugía General, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Hortal
- Servicio de Anestesiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Roberto Alonso
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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4
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Lominchar PL, Orue-Echebarria MI, Martín L, Lisbona CJ, Salcedo MM, Olmedilla L, Sharma H, Asencio JM, López-Baena JÁ. Hepatic flow is an intraoperative predictor of early allograft dysfunction in whole-graft deceased donor liver transplantation: An observational cohort study. World J Hepatol 2019; 11:689-700. [PMID: 31598193 PMCID: PMC6783401 DOI: 10.4254/wjh.v11.i9.689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/25/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early allograft dysfunction (EAD) after liver transplantation (LT) is an important cause of morbidity and mortality. To ensure adequate graft function, a critical hepatocellular mass is required in addition to an appropriate blood supply. We hypothesized that intraoperative measurement of portal venous and hepatic arterial flow may serve as a predictor in the diagnosis of EAD.
AIM To study whether hepatic flow is an independent predictor of EAD following LT.
METHODS This is an observational cohort study in a single institution. Hepatic arterial blood flow and portal venous blood flow were measured intraoperatively by transit flow. EAD was defined using the Olthoff criteria. Univariate and multivariate analyses were used to determine the intraoperative predictors of EAD. Survival analysis and prognostic factor analysis were performed using the Kaplan-Meier and Cox regression models.
RESULTS A total of 195 liver transplant procedures were performed between January 2008 and December 2014 in 188 patients. A total of 54 (27.7%) patients developed EAD. The median follow-up was 39 mo. Portal venous flow, hepatic arterial flow (HAF) and total hepatic arterial flow were associated with EAD in both the univariate and multivariate analyses. HAF is an independent prognostic factor for 30-d patient mortality.
CONCLUSION Intraoperative measurement of blood flow after reperfusion appears to be a predictor of EAD; Moreover, HAF should be considered a predictor of 30-d patient mortality.
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Affiliation(s)
- Pablo Lozano Lominchar
- General Surgery Department, Liver Transplant Unit, Hospital General Universitario Gregorio Maranon, Madrid 28007, Spain
| | - Maitane Igone Orue-Echebarria
- General Surgery Department, Liver Transplant Unit, Hospital General Universitario Gregorio Maranon, Madrid 28007, Spain
| | - Lorena Martín
- General Surgery Department, Liver Transplant Unit, Hospital General Universitario Gregorio Maranon, Madrid 28007, Spain
| | - Cristina Julia Lisbona
- Anesthesiology Department, Liver Transplant Unit, Hospital General Universitario Gregorio Maranon, Madrid 28007, Spain
| | - María Magdalena Salcedo
- Hepatology Department, Liver Transplant Unit, Hospital General Universitario Gregorio Maranon, Madrid 28007, Spain
| | - Luis Olmedilla
- Anesthesiology Department, Liver Transplant Unit, Hospital General Universitario Gregorio Maranon, Madrid 28007, Spain
| | - Hemant Sharma
- Department of Transplant Surgery, Oschner Medical Center, New Orleans, LA 70816, United States
| | - Jose Manuel Asencio
- General Surgery Department, Liver Transplant Unit, Hospital General Universitario Gregorio Maranon, Madrid 28007, Spain
| | - José Ángel López-Baena
- General Surgery Department, Liver Transplant Unit, Hospital General Universitario Gregorio Maranon, Madrid 28007, Spain
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5
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Lozano P, Orue-Echebarria MI, Asencio JM, Sharma H, Lisbona CJ, Olmedilla L, Pérez Peña JM, Salcedo MM, Skaro A, Velasco E, Colón A, Díaz-Zorita B, Rodríguez L, Ferreiroa J, López-Baena JÁ. Donor Risk Index Has an Impact in Intraoperative Measure of Hepatic Artery Flow and in Clearance of Indocyanine Green: An Observational Cohort Study. Transplant Proc 2019; 51:50-55. [PMID: 30655145 DOI: 10.1016/j.transproceed.2018.03.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/15/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The increase in indications for liver transplantation has led to acceptance of donors with expanded criteria. The donor risk index (DRI) was validated with the aim of being a predictive model of graft survival based on donor characteristics. Intraoperative arterial hepatic flow and indocyanine green clearance (plasma clearance rate of indocyanine green [ICG-PDR]) are easily measurable variables in the intraoperative period that may be influenced by graft quality. Our aim was to analyze the influence of DRI on intraoperative liver hemodynamic alterations and on intraoperative dynamic liver function testing (ICG-PDR). METHODS This investigation was an observational study of a single-center cohort (n = 228) with prospective data collection and retrospective data analysis. Measurement of intraoperative flow was made with a VeriQ flowmeter based on measurement of transit time (MFTT). The ICG-PDR was obtained from all patients with a LiMON monitor (Pulsion Medical Systems AG, Munich, Germany). DRI was calculated using a previously validated formula. Normally distributed variables were compared using Student's t test. Otherwise, the Mann-Whitney U test or Kruskal-Wallis test was applied, depending on whether there were 2 or more comparable groups. The qualitative variables and risk measurements were analyzed using the chi-square test. P < .05 was considered statistically significant. RESULTS DRI score (mean ± SD) was 1.58 ± 0.31. The group with DRI >1.7 (poor quality) had an intraoperative arterial flow of 234.2 ± 121.35 mL/min compared with the group having DRI < 1.7 (high quality), with an intraoperative arterial flow of 287.24 ± 156.84 mL/min (P = .02). The group with DRI >1.70 had an ICG-PDR of 14.75 ± 6.52%/min at 60 minutes after reperfusion compared to the group with DRI <1.70, with an ICG-PDR of 16.68 ± 6.47%/min at 60 minutes after reperfusion (P = .09). CONCLUSION Poor quality grafts have greater susceptibility to ischemia-reperfusion damage. Decreased intraoperative hepatic arterial flow may represent an increase in intrahepatic resistance early in the intraoperative period.
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Affiliation(s)
- P Lozano
- Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - M I Orue-Echebarria
- Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - J M Asencio
- Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - H Sharma
- Department of Multi-Organ Transplant Surgery, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - C J Lisbona
- Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - L Olmedilla
- Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - J M Pérez Peña
- Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - M M Salcedo
- Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - A Skaro
- Department of Multi-Organ Transplant Surgery, University of Western Ontario, London, Ontario, Canada
| | - E Velasco
- Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - A Colón
- Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - B Díaz-Zorita
- Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - L Rodríguez
- Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - J Ferreiroa
- Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - J Á López-Baena
- Liver Transplant Unit, Hospital Universitario Gregorio Marañón de Madrid, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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