raffinose 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

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