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Acute kidney injury and post-reperfusion syndrome in liver transplantation

World Journal of Gastroenterology 2016年第42期22卷 9314-9323页

作者： Ilaria Umbro Francesca Tinti Irene Scalera Felicity Evison Bridget Gunson Adnan Sharif James Ferguson Paolo Muiesan Anna Paola Mitterhofer Department of Clinical Medicine Nephrology and Dialysis B Sapienza University of Rome The Liver Unit Queen Elizabeth Hospital Birmingham Department of Health Informatics University Hospitals Birmingham NHS Foundation Trust National Institute for Health Research Birmingham Liver Biomedical Research Unit the Liver Unit Queen Elizabeth Hospital Birmingham the Institute of Immunology and Immunotherapy University of Birmingham Department of Nephrology and Transplantation Queen Elizabeth Hospital Birmingham

In the past decades liver transplantation(LT) has become the treatment of choice for patients with end stage liver disease(ESLD). The chronic shortage of cadaveric organs for transplantation led to the utilization of a greater number of marginal donors such as older donors or donors after circulatory death(DCD). The improved survival of transplanted patients has increased the frequency of long-term complications, in particular chronic kidney disease(CKD). Acute kidney injury(AKI) post-LT has been recently recognized as an important risk factor for the occurrence of denovo CKD in the long-term outcome. The onset of AKI post-LT is multifactorial, with pre-LT risk factors involved, including higher Model for End-stage Liver Disease score, more sever ESLD and pre-existing renal dysfunction, either with intra-operative conditions, in particular ischaemia reperfusion injury responsible for post-reperfusion syndrome(PRS) that can influence recipient's morbidity and mortality. post-reperfusion syndrome-induced AKI is an important complication post-LT that characterizes kidney involvement caused by PRS with mechanisms not clearly understood and implication on graft and patient survival. Since preLT risk factors may influence intra-operative events responsible for PRS-induced AKI, we aim to consider all the relevant aspects involved in PRS-induced AKI in the setting of LT and to identify all studies that better clarified the specific mechanisms linking PRS and AKI. A Pub Med search was conducted using the terms liver transplantation AND acute kidney injury; liver transplantation AND post-reperfusion syndrome; acute kidney injury AND post-reperfusion syndrome; acute kidney injury AND DCD AND liver transplantation. Five hundred seventy four articles were retrieved on Pub Med search. Results were limited to title/abstract of English-language articles published between 2000 and 2015. Twenty-three studies were identified that specifically evaluated incidence, risk factors and outc

关键词： Liver transplantation Acute kidney injury post-reperfusion syndrome Donation after circulatory death Chronic kidney disease

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Intraoperative management and early post-operative outcomes of patients with coronary artery disease who underwent orthotopic liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2020年第1期19卷 12-16页

作者： Hai-Ying Kong Xian Zhao Kui-Rong Wang Department of Anesthesiology The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003China Department of Anesthesiology International HospitalZhejiang UniversityHangzhou 310000China

Background: Coronary artery disease (CAD) is frequently observed in aging end-stage liver disease (ESLD) patients who require orthotopic liver transplantation (OLT). This situation is challenging for both the pa- tients and the medical staff. Methods: We retrospectively studied the case records of 26 ESLD patients with CAD who underwent OLT with total clamping of the inferior vena cava between 2014 and 2018. We analyzed the details of the pre-operative evaluation, intraoperative anesthetic management and post-operative prognosis of these patients. Results: All patients tolerated the anhepatic stage well. post-reperfusion syndrome (PRS) was observed in 13 patients (50%) and 2 of them were severe but corrected well. ST-segment depression was frequently observed during the anhepatic stage and reperfusion stage. No mortality due to cardiac-related events occurred among the patients during hospitalization. OLT with the modi ed piggyback technique could successfully be performed in ESLD patients with mild and moderate CAD. Conclusions: A thorough evaluation and optimization of recipients, strict monitoring and optimized man-agement of circulation, knowledge of the complicated changes during OLT procedures, and strategies to ameliorate post-reperfusion syndrome favorite the outcomes.

关键词： Orthotopic liver transplantation Coronary artery disease post-reperfusion syndrome

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