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Comparable prognosis in different neonatal histidine-tryptophan-ketoglutarate dosage management

Chinese Medical Journal 2021年第24期134卷 2968-2975页

作者： Li-Ting Bai Yuan-Yuan Tong Jin-Ping Liu Zheng-Yi Feng Ju Zhao Sheng-Wen Guo Yu Jin Pei-Yao Zhang Yi-Xuan Li Department of Cardiopulmonary Bypass Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China

Background:histidine-tryptophan-ketoglutarate(HTK)is a solution commonly used for organ transplantation.However,there is no certified fixed regimen for on-pump heart surgery in neonates.We aimed to retrospectively evaluate the outcomes related to different HTK dosages and to analyze the safety of high-dosage perfusion.Methods:A total of 146 neonates who underwent on-pump heart surgery with single-shot HTK perfusion were divided into two groups according to HTK dosages:a standard-dose(SD)group(n=63,40 mL/kg60 mL/kg).Propensity score matching(PSM)was performed to control confounding bias.Results:The SD group had a higher weight(3.7±0.4 vs.3.4±0.4 kg,P0.05).The incidences of post-operative complications were not significantly different between the two groups.There were no significant differences in ventilation time,intensive care unit stay,and post-operative hospital stay(P>0.05).Follow-up echocardiography outcomes at 1 month,3 to 6 months,and 1 year showed that left ventricular ejection fraction and end-diastolic dimension were comparable between the two groups.Conclusions:In neonatal on-pump cardiac surgery patients,single-shot HD(>60 mL/kg)HTK perfusion had a comparable heart protection effect and short-term post-operative prognosis as standard dosage perfusion of 40 to 60 mL/kg.Thus,this study provides supporting evidence of the safety of HD HTK perfusion.

关键词： histidine-tryptophan-ketoglutarate Neonate Perfusion dosage Cardiac recovery Prognosis

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Compared efficacy of University of Wisconsin and histidine-tryptophan-ketoglutarate solutions in ex-situ liver resection and autotransplantation for end-stage hepatic alveolar echinococcosis patients

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Hepatobiliary & Pancreatic Diseases International 2019年第5期18卷 430-438页

作者： Shadike Apaer Tuerhongjiang Tuxun Tao Li Tuerganaili Aji Jiangduosi Payiziwula Jin-Ming Zhao Ying-Mei Shao Hao Wen State Key Laboratory of Pathogenesis PreventionTreatment of High Incidence Diseases in Central AsiaXinjiang Medical UniversityUrumqi 830011China Department of Liver Transplantation and Laparoscopic Surgery Center of Digestive and Vascular Surgerythe First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054China Department of Hepatobiliary and Hydatid Surgery Center of Digestive and Vascular Surgerythe First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054China WHO Collaborating Center for Prevention and Care Management of Echinococcosis the First Affiliated Hospital of Xinjiang Medical University and Xinjiang Center for Disease ControlUrumqi 830054China

Background: The University of Wisconsin (UW) and histidine-tryptophan-ketoglutarate (HTK) solutions are the two most frequently used liver graft preservation fluids. The present study aimed to compare their efficacy in end-stage hepatic alveolar echinococcosis patients who underwent ex-situ liver resection and autotransplantation (ELRA). Methods: A total of 81 patients received ELRA from August 2010 to March 2018. They were allocated into UW ( n = 48) and HTK groups ( n = 33) based on the type of solutions used. Demographic and operational data were retrospectively analyzed. Primary outcomes included 90-day mortality, incidence of early graft loss, primary dysfunction, and postoperative complications. Results: Demographic and operational characteristics were similarly distributed in the two groups. No statistically significant differences were observed with regard to 90-day mortality (12.77% vs. 12.12%) and early graft loss rate (8.51% vs. 9.09%) between the two groups. Patients in the UW and HTK groups showed a primary dysfunction rate of 27.66% and 27.27%, respectively. The UW group exhibited a higher incidence tendency of biliary complications, albeit with no statistical significance. Conclusions: This is the largest cohort study comparing the efficacy of the UW and HTK organ-preserving solutions in end-stage hepatic alveolar echinococcosis patients in ELRA settings. UW and HTK solutions presented similar efficacy and safety. A randomized clinical trial with larger scale is needed for further investigation in future clinical applications.

关键词： University of Wisconsin histidine-tryptophan-ketoglutarate Liver autotransplantation Alveolar echinococcosis Efficacy

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Influence of perfusate on liver viability during hypothermic machine perfusion

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World Journal of Gastroenterology 2015年第29期21卷 8848-8857页

作者： Jun-Jun Jia Jing Zhang Jian-Hui Li Xu-Dong Chen Li Jiang Yan-Fei Zhou Ning He Hai-Yang Xie Lin Zhou Shu-Sen Zheng Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases The First Affiliated Hospital College of Medicine Zhejiang University Key Laboratory of Combined Multiorgan Transplantation Ministry of Public Health Zhejiang University School of Medicine Department of Hepatobiliary and Pancreatic Surgery First Affiliated Hospital Zhejiang University School of Medicine Department of Vascular Surgery First Affiliated Hospital Zhejiang University School of Medicine

AIM: To optimize the perfusates used for hypothermicmachine perfusion(HMP).METHODS: Sprague-Dawley rats were assigned randomly to three groups(n = 12 per group) that received either saline, University of Wisconsin coldstorage solution(UW) or histidine-tryptophan-ketoglutarate solution(HTK) as the perfusate. Each group was divided into two subgroups: static cold storage(SCS) and HMP(n = 6 per subgroup). The liver graft was retrieved according to the method described by Kamada. For the SCS group, the graft was directly placed into cold perfusate(0-4?℃) for 6 h after liver isolation while the portal vein of the graft was connected to the perfusion machine for the HMP group. Then the perfusates were collected at different time points for analysis of aspartate aminotransferase(AST), alanine transaminase(ALT) and lactate dehydrogenase(LDH) levels. Liver tissues were obtained for evaluation of histology, dry/wet weight(D/W) ratio, and malondialdehyde(MDA) and adenosine-triphosphate(ATP) levels. The portal vein pressure and velocity were monitored in real time in all HMP subgroups.RESULTS: Comparison of HMP and SCS: Regardless of the perfusate, HMP improved the architecture of donor graft in reducing the congestion around sinusoids and central vein and maintaining sinusoid lining in morphology; HMP improved liver function in terms of ALT, AST and LDH, especially during the 3-6 h period(SCS vs HMP using saline: ALT3, 225.00 ± 105.62 vs 49.50 ± 18.50, P = 0.047; LDH3, 1362.17 ± 563.30 vs 325.75 ± 147.43, P = 0.041; UW: LDH6, 2880.14 ± 948.46 vs 2135.00 ± 174.27, P = 0.049; HTK, AST6, 307.50 ± 52.95 vs 185.20 ± 20.46, P = 0.041); HMP decreased MDA level(saline, 2.79 ± 0.30 vs 1.09 ± 0.09, P = 0.008; UW, 3.01 ± 0.77 vs 1.23 ± 0.68, P = 0.005; HTK, 3.30 ± 0.52 vs 1.56 ± 0.22, P = 0.006). Comparison among HMP subgroups: HTK showed less portal vein resistance than UW and saline(vs saline, 3.41 ± 0.49 vs 5.00 ± 0.38, P < 0.001; vs UW, 3.41 ± 0.49 vs 4.52 ± 0.63, P = 0.007); UW reduced edema most efficiently(vs saline, 0.68 ± 0.0

关键词： Hypothermic machine perfusion Staticcold storage Liver viability Wisconsin cold-storagesolution histidine-tryptophan-ketoglutarate solution

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