allopurinol and Hypotension

One of the main concerns in liver transplant is the prolonged ischemia time, which may lead to primary graft nonfunction or delayed function. N-acetylcysteine is known as a hepato-protective agent in different studies, which may improve human hepatocyte viability in steatotic donor livers. This study investigated whether N-acetylcysteine can decrease the rate of ischemia-reperfusion syndrome and improve short-term outcome in liver transplant recipients.. This was a double-blind, randomized, control clinical trial of 115 patients. Between April 2012 and January 2013, patients with orthotopic liver transplant were randomly divided into 2 groups; in 49 cases N-acetylcysteine was added to University of Wisconsin solution as the preservative liquid (experimental group), and in 66 cases standard University of Wisconsin solution was used (control group). We compared postreperfusion hypotension, inotrope requirement before and after portal reperfusion, intermittent arterial blood gas analysis and potassium measurement, pathological review of transplanted liver, in-hospital complications, morbidity, and mortality.. There was no significant difference between the groups regarding time to hepatic artery reperfusion, hospital stay, vascular complications, inotrope requirement before and after portal declamping, and blood gas analysis. Hypotension after portal reperfusion was significantly more common in experimental group compared with control group (P = .005). Retransplant and in-hospital mortality were comparable between the groups.. Preservation of the liver inside Univer-sity of Wisconsin solution plus N-acetylcysteine did not change the rate of ischemia reperfusion injury and short-term outcome in liver transplant recipients.

Topics: Acetylcysteine; Adenosine; Allopurinol; Cold Ischemia; Double-Blind Method; Female; Glutathione; Hospital Mortality; Humans; Hypotension; Insulin; Iran; Length of Stay; Liver Transplantation; Male; Middle Aged; Operative Time; Organ Preservation Solutions; Perfusion; Protective Agents; Raffinose; Reperfusion Injury; Risk Factors; Time Factors; Treatment Outcome; Warm Ischemia

The greatest hemodynamic instability during orthotopic liver transplantation occurs at graft reperfusion. Many factors have been implicated.. To compare hemodynamic changes after reperfusion in grafted livers preserved with histidine-tryptophan-ketoglutarate (HTK) solution versus grafted livers preserved with University of Wisconsin (UW) solution.. In this prospective study, we randomly divided 89 patients who underwent deceased donor liver transplantation into 2 groups: the UW group and the HTK group. The HTK group was further divided into 2 subgroups: flushed and not flushed before reperfusion. The patients were monitored with hemodynamic and metabolic parameters at 3 times: after the skin incision, 5 minutes before reperfusion, and 5 minutes after reperfusion.. Hemodynamic parameters in the UW group had not changed significantly at 5 minutes before reperfusion or 5 minutes after reperfusion (P = .45), and the incidence of hypotension after reperfusion in the UW group was 20%. In both HTK groups, the mean arterial pressure 5 minutes after reperfusion was significantly lower than at 5 minutes before reperfusion (P = .002); the incidence of hypotension after reperfusion in the nonflushed HTK group was 83.3% and in the flushed HTK group, 65.5%.. The incidence of hypotension after reperfusion is greater if HTK solution rather than UW solution is used. Flushing of grafted livers preserved with HTK solution might eliminate some vasoactive substances found in HTK solution.

Topics: Adenosine; Adult; Allopurinol; Blood Gas Analysis; Female; Glucose; Glutathione; Hemodynamics; Humans; Hypotension; Incidence; Insulin; Liver Transplantation; Male; Mannitol; Organ Preservation; Organ Preservation Solutions; Potassium Chloride; Procaine; Prospective Studies; Raffinose; Reperfusion; Therapeutic Irrigation

Topics: Adenosine; Allopurinol; Animals; Gluconates; Glutathione; Graft Survival; Heart Arrest; Hypotension; Insulin; Liver; Liver Transplantation; Organ Preservation; Organ Preservation Solutions; Pentoxifylline; Perfusion; Raffinose; Swine; Transplantation, Homologous

Recent studies suggest that the cardiac dysfunction that occurs after a major burn is mediated by oxygen-derived free radicals. This hypothesis is based on the fact that superoxide dismutase and catalase, given with fluid resuscitation from burn injury, provided significant cardioprotection.. In this present study, rats received either enteral allopurinol or tungsten-enriched diets to determine if xanthine oxidase mediates postburn defects in cardiac contraction and relaxation. Polymorphonuclear neutrophil (PMN) were depleted to examine the contribution of PMN-derived factors to postburn cardiac dysfunction. Rats were divided into eight groups: groups 1 to 6 received regular chow, and groups 7 and 8 received tungsten-enriched diets for 14 days before study. Groups 2, 4, 6, and 8 were given a third-degree burn comprising 43 +/- 2 percent total body surface area and were resuscitated with Ringer's lactated solution for 24 hours (4 mL/kg/percent burn). In group 2, burned rats received fluid resuscitation alone; in group 4 (n = 10), rats were given allopurinol, 10 mg/kg daily by gastric lavage for five days preburn, group 6 (n = 11) received vinblastine (0.75 mg/kg) four days preburn, and group 8 (n = 11) received tungsten-enriched diets for 14 days before burn; sham burn controls included vehicle-treated (n = 10), allopurinol-treated (n = 8), PMN-depleted (n = 8), and tungsten-fed rats (n = 11) (groups 1, 3, 5, and 7, respectively).. Burn injury produced mild hypotension, hypothermia, bradycardia, and a significant decrease in left ventricular performance, despite aggressive fluid resuscitation (group 2). Allopurinol, tungsten-enriched diets, and PMN depletion partially attenuated burn-induced cardiac contractile dysfunction and improved left ventricular responsiveness to increases in preload, coronary flow rate and exogenous calcium.. Our data suggest that xanthine oxidase-derived oxygen metabolites and PMN-derived mediators contribute to postburn cardiac contractile deficits.

Topics: Allopurinol; Animals; Body Surface Area; Bradycardia; Burns; Coronary Circulation; Fluid Therapy; Heart Diseases; Hypotension; Hypothermia; Isotonic Solutions; Leukocyte Count; Male; Myocardial Contraction; Neutrophils; Rats; Rats, Sprague-Dawley; Ringer's Lactate; Tungsten; Ventricular Dysfunction, Left; Vinblastine; Xanthine Oxidase

Hypothermically preserved rat livers were studied with proton magnetic resonance imaging (1H-MRI) under proton density-, spin-lattice relaxation time-, spin-spin relaxation time- and diffusion-weighted (P-W, T1-W, T2-W and D-W) conditions. Relative signal intensities (RSI) of the liver to distilled water in terms of P-W, T1-W, T2-W and D-W increased time-dependently during 12 h hypothermic (4 degrees C) preservation with saline, while these parameters did not increase during preservation with University of Wisconsin (UW) solution. One-hour Wiggers' hypotensive treatment before the harvesting increased the RSIs of P-W, T2-W and D-W, and the subsequent 12-hour preservation with UW solution did not improve the increased RSIs. These results suggest that 1H-MRI has potential application in evaluating the biophysical changes of water molecules in the liver graft, which were measured by placing the harvested liver in a plastic bag under a magnetic field at a low temperature.

Topics: Adenosine; Allopurinol; Animals; Cryopreservation; Glutathione; Hypotension; In Vitro Techniques; Insulin; Liver; Magnetic Resonance Imaging; Male; Organ Preservation Solutions; Protons; Raffinose; Rats; Rats, Wistar; Shock, Hemorrhagic; Sodium Chloride; Time Factors; Water

Topics: Adenosine; Adult; Age Factors; Allopurinol; Amylases; Body Mass Index; Cell Separation; Cell Survival; Glutathione; Humans; Hypotension; Insulin; Islets of Langerhans; Organ Preservation Solutions; Pancreatectomy; Perfusion; Raffinose; Tissue Donors

Topics: Adenosine Triphosphate; Allopurinol; Animals; Blood Pressure; Dogs; Heart Rate; Hypertonic Solutions; Hypotension; Kidney Transplantation; Organ Preservation; Renal Circulation; Reperfusion Injury; Time Factors; Transplantation, Autologous

Topics: Adenosine; Allopurinol; Bradycardia; Glutathione; Humans; Hypotension; Insulin; Organ Preservation Solutions; Raffinose; Solutions; Tissue Preservation

The mechanism of tissue and cell injury in ischaemic bowel necrosis is unclear. The present study investigated the role of oxygen derived free radicals in the development of bowel necrosis using injections of platelet activating factor (PAF) into the mesenteric vasculature. Animals were pretreated with allopurinol or superoxide dismutase together with catalase, before administration of PAF. Superoxide dismutase/catalase markedly improved the PAF-induced lesions, indicating that most of the intestinal damage after PAF injection is because of the release of oxygen radicals. The major source of oxygen radicals is xanthine oxidase, as allopurinol ameliorated small bowel lesions. Pretreatment with allopurinol produced a significant (p less than 0.01) preventive effect on PAF induced hypotension. In contrast, superoxide dismutase/catalase did not alter PAF induced hypotension. Superoxide dismutase/catalase pretreatment improved PAF induced haemoconcentration and leucopenia, while allopurinol showed no effect.

Topics: Allopurinol; Animals; Catalase; Enterocolitis, Pseudomembranous; Free Radicals; Hypotension; Intestinal Mucosa; Intestines; Male; Mesenteric Arteries; Oxygen; Platelet Activating Factor; Rats; Rats, Inbred Strains; Superoxide Dismutase; Vasoconstriction

Characteristic mucosal lesions develop in the small intestine during ischaemia and hypotension. This tissue damage can be further aggravated in the immediate reperfusion phase, presumably secondary to the generation of oxygen free radicals which have been proposed to be generated in this situation through the hypoxanthine-xanthine oxidase system. This was further investigated in the cat small intestine using a standardized regional intestinal hypotension model in which the effects of allopurinol (a xanthine oxidase inhibitor) were compared to those of an exogenous supply of inosine. The grade of mucosal damage, the nucleotide levels, the concentrations of hypoxanthine, total and oxidized glutathione, and of conjugated dienes were measured in the intestinal tissue. The results indicate that oxygen radicals generated by xanthine oxidase are very important, but not the only significant factor in the small intestinal reperfusion damage.

Topics: Adenosine Diphosphate; Adenosine Monophosphate; Adenosine Triphosphate; Allopurinol; Animals; Cats; Female; Glutathione; Hypotension; Hypoxanthine; Hypoxanthines; Inosine; Inosine Monophosphate; Intestinal Mucosa; Intestine, Small; Ischemia; Male; Oxidation-Reduction; Superoxides

Topics: Allopurinol; Animals; Atropine; Digestive System; Dogs; Heart Ventricles; Hypotension; Hypoxanthines; Kidney; Liver; Lung; Microscopy, Electron; Myocardium; Prognosis; Shock, Hemorrhagic; Spleen