raffinose and Thrombosis

Topics: Adenosine; Allopurinol; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Glutathione; Humans; Hypertonic Solutions; Insulin; Kidney Failure, Chronic; Kidney Transplantation; Organ Preservation; Organ Preservation Solutions; Pancreas; Pancreas Transplantation; Postoperative Complications; Raffinose; Retrospective Studies; Thrombosis

This study compares biliary complication rates associated with use of two different preservative solutions, Histidine-Tryptophan-Ketoglutarate (HTK) and University of Wisconsin (UW), utilized in orthotopic liver transplantation (LT) with donations after cardiac death (DCDs).. Between 1997-2010, we retrospectively studied 35 LTs performed utilizing DCD donors, preserved either with HTK (n=17) or UW(n=18). Biliary complications were defined by the presence of anastomotic strictures, non-anastomotic strictures, and/or biliary leak on endoscopic retrograde cholangiopancreatography.. HTK and UW cohorts were similar in terms of demographics as well as pre- and post-operative biochemical profile. Donor age was significantly higher among HTK compared to UW recipients (41.5 ± 11.9 vs. 26.2 ± 8.8 years, p<0.001). The incidence of post-LT biliary complications was higher in the HTK group (76% vs. 39% in UW group, p=0.041). Hepatic arterial thrombosis (HAT) was observed among 3 HTK patients (17.7%) and 1 UW patient (5.6%), p=0.33. No patients underwent retransplantation in UW group, five recipients in HTK group underwent retransplantation (29%), p=0.019; 4 due to biliary complications and 1 due to HAT.. This single-center study reveals that the use of HTK preservative among DCD donors is associated with an increased risk of biliary complications. Multicenter retrospective studies are suggested to further verify this observation.

Topics: Adenosine; Adult; Allopurinol; Anastomosis, Surgical; Anastomotic Leak; Biliary Tract; Constriction, Pathologic; Female; Glucose; Glutathione; Hepatic Artery; Humans; Insulin; Liver Transplantation; Male; Mannitol; Middle Aged; Organ Preservation Solutions; Postoperative Complications; Potassium Chloride; Procaine; Raffinose; Reoperation; Retrospective Studies; Thrombosis; Tissue Donors

Arterial or venous homografts are frequently implanted for vascular reconstruction in orthotopic liver transplantation (OLT). When fresh vascular homografts (VH) from the same donor were not available, VH from another donor preserved at 4 degrees C in Terasaki (Ter) solution (modified lymphocyte culture medium) were used.. The clinical results after implantation of Ter-stored VH versus fresh VH in the revascularization of pediatric OLT were studied retrospectively. Short- and long-term follow-up of vascular patency was carried out by doppler ultrasonography in each case. A histological and bacteriological study of nonimplanted VH stored at 4 degrees C in saline (Sal), Ter and University of Wisconsin (UW) solutions for various time periods (days 0-28) was also undertaken.. Between 1989 and 1996, 21 iliac arteries and 21 iliac veins preserved in Ter solution (mean preservation time: 8 days; range 1-26) and 100 fresh VH (68 arteries and 32 veins) (preservation time: 8 hr, range 4-21) were used in pediatric OLT. Thrombosis rates were 0 of 21 for stored arteries vs. 7 of 68 (10%) for fresh arteries (NS) and 3 of 21 (14%) for stored veins vs. 3 of 32 (9%) for fresh veins (NS). Actuarial graft survival rates were similar in both groups. Histological analysis of stored, nonimplanted VH invariably showed endothelial destruction within 24-48 hr after procurement. The bacteriological study showed contamination rates of 14 of 25 (56%) for Sal-stored VH, 5 of 25 (20%) for UW, and 1 of 19 (5%) for Ter (Sal vs. UW and Sal vs. Ter: P<0.01; UW vs. Ter: NS).. Ter-preserved cadaveric VH could be safely used in OLT despite early destruction of endothelium.

Topics: Adenosine; Adolescent; Allopurinol; Bacteria; Child; Child, Preschool; Cryopreservation; Endothelium, Vascular; Glutathione; Humans; Iliac Artery; Iliac Vein; Infant; Insulin; Isotonic Solutions; Liver; Liver Transplantation; Organ Preservation Solutions; Postoperative Complications; Raffinose; Retrospective Studies; Thrombosis; Tissue Donors; Vascular Patency

Topics: Adenosine; Adolescent; Adult; Allopurinol; Cadaver; Female; Glutathione; Graft Rejection; Humans; Insulin; Ischemia; Isotonic Solutions; Kidney; Kidney Transplantation; Male; Middle Aged; Organ Preservation; Organ Preservation Solutions; Pancreas; Pancreas Transplantation; Perfusion; Raffinose; Ringer's Solution; Therapeutic Irrigation; Thrombosis; Tissue and Organ Procurement; Tissue Donors

Two non-randomized groups of 100 kidney transplants each were compared in relation to the flush-out solution used. The two groups were similar with the exceptions of the number of multiple artery kidneys and the proportion of kidneys procured in our center. The rate of vascular complications such as arterial venous thrombosis and renal artery stenosis was higher in the Eurocollins (19) group than in the UW group (4) p < 0.01, even if the multiple artery kidneys are excluded. These results need to be confirmed by a randomized study but it is clear that the use of the UW solution leads to a better arterial flow with fewer vascular complications.

Topics: Adenosine; Adult; Allopurinol; Glutathione; Humans; Hypertonic Solutions; Insulin; Kidney Transplantation; Organ Preservation; Organ Preservation Solutions; Raffinose; Renal Artery Obstruction; Renal Veins; Thrombosis

Poor back-table perfusion of a renal allograft may occur as a result of intravascular thrombosis of the renal artery branches. We herein report such a case where back-table angioscopy was performed to confirm the diagnosis, followed by successful thrombolysis using urokinase under hypothermic conditions.

Topics: Adenosine; Allopurinol; Angioscopy; Glutathione; Humans; Insulin; Kidney Transplantation; Male; Middle Aged; Organ Preservation Solutions; Raffinose; Renal Artery Obstruction; Streptokinase; Thrombolytic Therapy; Thrombosis; Transplantation, Homologous

Topics: Adenosine; Adult; Allopurinol; Amylases; Blood Glucose; Creatinine; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Duodenum; Glutathione; Histocompatibility Testing; Humans; Insulin; Kidney Failure, Chronic; Kidney Transplantation; Male; Organ Preservation; Organ Preservation Solutions; Pancreas Transplantation; Raffinose; Solutions; Spleen; Thrombosis; Tomography, X-Ray Computed; Transplantation, Homologous

Hepatic artery thrombosis (HAT) after liver transplantation (LTx) usually mandates retransplantation. Prolonged preservation with Eurocollins solution has been associated with HAT. We reviewed our experience with 359 LTx patients to identify risk factors for HAT. All grafts were preserved in University of Wisconsin solution. HAT developed in 12 patients (3%) within 50 days. Seven patients were asymptomatic; four presented with biliary sepsis and 1 with poor graft function. Two patients had suffered acute rejection; another 2 had severe preservation injury. Technical problems accounted for 4 cases; in the remaining 8, no etiology was found. Diagnosis was at a mean 14.7 days after LTx. One patient maintains normal graft function 3 years after LTx without intervention. Eight underwent re-LTx, 3 of whom died. Routine surveillance via duplex enabled early diagnosis and revascularization in 3 patients; in all 3, no biliary complications occurred between 6 and 20 months. Overall graft and patient survival after HAT were 33.3% and 75%, respectively. Cold ischemic time (CIT) averaged 813 min in patients with HAT and 669 min in those without HAT (P < .05). HAT occurred in 7/165 patients with CIT > 12 hr, and in 3/234 patients with CIT < 12 hr (P = 0.0699). By avoiding CIT > 12 hr, we have recently avoided HAT in 78 consecutive patients. We conclude that CIT > 12 hr may increase the risk of HAT. When HAT is diagnosed before biliary sepsis develops, flow can often be restored and retransplantation averted.

Topics: Adenosine; Adult; Aged; Allopurinol; Child, Preschool; Cold Temperature; Glutathione; Hepatic Artery; Humans; Insulin; Ischemia; Liver; Liver Transplantation; Middle Aged; Organ Preservation; Organ Preservation Solutions; Raffinose; Thrombosis; Time Factors; Ultrasonography

An unusual type of diffuse biliary tract injury after liver transplantation that is characterized by multiple intrahepatic biliary strictures, ductal dilatations, fluid collections, or intrahepatic abscesses has been identified. Over a 5-year period, a total of 10 patients (2%) developed diffuse intrahepatic biliary injury with established vascular patency and no obvious source for their biliary tract pathology. All patients received livers preserved in University of Wisconsin solution with a mean preservation time of 16 hours. This biliary tract injury was associated with the presence of severe preservation injury and Roux limb biliary reconstruction. Of the 10 patients, 5 were treated nonoperatively with multiple stricture dilations and stent placements, 3 underwent retransplantation, 1 was treated operatively with hepaticojejunostomy, and 1 died of sepsis. This study suggests that this complication appears to be related to preservation injury and that the etiology may be ischemic in origin.

Topics: Adenosine; Adolescent; Adult; Aged; Alanine Transaminase; Allopurinol; Aspartate Aminotransferases; Bile Duct Diseases; Biliary Tract Diseases; Child; Child, Preschool; Cholangitis; Follow-Up Studies; Glutathione; Graft Survival; Hepatic Artery; Humans; Hypertonic Solutions; Infant; Infant, Newborn; Insulin; Jaundice; Liver; Liver Transplantation; Middle Aged; Organ Preservation; Organ Preservation Solutions; Raffinose; Reoperation; Retrospective Studies; Solutions; Thrombosis

Topics: Adenosine; Allopurinol; Animals; Dogs; Female; Glutathione; Iliac Artery; Insulin; Microscopy, Electron; Muscle, Smooth, Vascular; Organ Preservation; Organ Preservation Solutions; Raffinose; Solutions; Thrombosis; Transplantation, Homologous

A retrospective analysis of all organs that were preserved with University of Wisconsin solution was undertaken to assess the impact of this solution on early allograft function. From May 1987 until June 1990, 181 livers, 92 pancreata, and 92 kidneys were preserved with University of Wisconsin solution for extended periods of time. The mean (+/- SD) preservation times were as follows: liver, 12.6 +/- 4.5 hours; pancreas, 16.7 +/- 4.4 hours; and kidney, 18.3 +/- 4.3 hours. The overall rate of primary nonfunction and hepatic artery thrombosis were 6.1% and 3.9%, respectively. No differences in the rates of primary nonfunction and hepatic artery thrombosis were noted for combined liver-pancreas procurement vs isolated liver retrievals or when reduced-size liver transplants were compared with nonreduced liver transplants. Likewise, no difference in primary nonfunction or hepatic artery thrombosis was seen in livers that were preserved for less than 6, 6 to 12, and greater than 12 hours. However, serum aminotransferase levels and prothrombin times were lower on the first postoperative day in livers that were preserved for less than 6 hours when compared with 6 to 12 or greater than 12 hours. Early pancreatic allograft function was also excellent for up to 24 hours of cold-storage preservation. All patients were immediately insulin independent, and there were no cases of initial nonfunction or graft pancreatitis. There were only two cases (2.2%) of pancreatic vascular thrombosis in this series. No difference in pancreatic function was noted for organs that were preserved for less than 6, 6 to 12, or greater than 12 hours. Likewise, renal allograft function was excellent, with only two patients (2.2%) requiring postoperative hemodialysis. The actuarial 1-month patient survival for liver and pancreas-kidney transplant recipients was 91.5% and 98.9%, respectively. Actuarial 1-month allograft survival for liver, pancreas, and kidney transplants was 83.0%, 96.7%, and 97.8%, respectively. In conclusion, University of Wisconsin solution represents a significant advancement in cold-storage organ preservation and is ideally suited as a universal intra-abdominal aortic-flush and cold-storage solution.

Topics: Adenosine; Adolescent; Allopurinol; Child; Child, Preschool; Glutathione; Graft Survival; Hepatic Artery; Humans; Infant; Insulin; Kidney Transplantation; Liver; Liver Transplantation; Organ Preservation; Organ Preservation Solutions; Pancreas; Pancreas Transplantation; Postoperative Complications; Raffinose; Reoperation; Solutions; Thrombosis; Time Factors