Clinical Implications of Hepatic Preservation Injury After Adult Liver Transplantation

Several advances in organ preservation have allowed for improved results after liver transplantation; however, little information is available regarding the clinical impact of preservation injury on the postoperative course. The medical records of 889 liver transplants were retrospectively reviewed. Preservation injury was classified according to postoperative aspartate aminotransferase values as minor (<1000 U/L), moderate (1000-5000 U/L), or severe (>5000 U/L). The following criteria were analyzed and compared according to the extent of preservation injury: patient and graft survival, retransplantation rate, duration of hospitalization and postoperative ventilation, as well as incidence of rejection, infection, and hemodialysis. The majority of patients received a liver with minor preservation injury (75.9%), whereas 22.7% and 1.3% of grafts showed moderate or severe injury. Graft survival was significantly lower in patients with severe preservation injury, when compared to minor or moderate injury. The relative risk for initial nonfunction was 39.36-fold increased (95% confidence interval (ci): 10.3-150.2), as it was increased for duration of postoperative ventilation (6.92-fold; 95%ci: 2.1-22.3) and hemodialysis (6.13-fold; 95%ci: 1.9-19.3). Since the incidence of retransplantation was significantly increased (50%), patient survival remained comparable between all groups. Severe preservation injury had a tremendous impact on the postoperative clinical course, requiring the maximum medical effort to achieve adequate patient survival.     

Treatment of osteoporosis after liver transplantation with ibandronate

Osteoporosis is a major side‐effect after liver transplantation (LTX). Therefore, the objective of the study was to evaluate the efficacy of ibandronate to reduce fractures after LTX. Seventy‐four patients after LTX were included in the study and measurements of bone mineral density (BMD) of lumbar spine and proximal femur using dual energy X‐ray absorptiometry (DEXA) were performed prior to and 3, 6, 12 and 24 months after surgery. The study group (IBA) consisted of 34 patients who received calcium (1 g/day), vitamin D3 (800–1000 IE/day) and ibandronate 2 mg every 3 months intravenously for 1 year. The control group consisted of 40 patients (CON) who received calcium and vitamin D3 at the same dosages. Prevalence of new fractures was predefined as primary endpoint. Changes of BMD and biochemical markers of bone metabolism were also investigated. In all patients, we found a reduction of BMD in the first few months after LTX. In the lumbar spine and the proximal femur the maximum reduction occurred 3 and 6 months post‐LTX. One and 2 years after transplantation, the group receiving ibandronate demonstrated a better recovery from loss of BMD and a significantly lower prevalence of fractures (IBA 2 vs. CON 10 P < 0.04, χ²). Ibandronate with calcium and vitamin D3 reduces the BMD‐loss after LTX and decreases the rate of bone fractures significantly.     

Die intraoperative Messung der hydraulischen Impedanz—ein Prognosekriterium für die Offenheitsrate femorokruraler Bypässe

Zusammenfassung Bei 68 femorokruralen PTFE-Bypassanlagen wurde mit Hilfe der extrakorporalen Bypassflowmessung (EBF) die hydraulische Impedanz sowohl des gesamten Abstromgebietes als auch der selektiven distalen ante- und retrograden Ausstromregionen gemessen. Bei der EBF-Methode wird ein Silikonschlauch temporär zwischen die A. femoralis communis und dem kruralen Anschlussgefäß platziert. In diesem temporären Bypass befanden sich ein elektromagnetischer Flussmesskopf sowie ein Anschluss zur Druckmessung. Die gemessenen hämodynamischen und Impedanzparameter wurden mit den primären und sekundären Offenheitsraten der Bypässe nach 3 Jahren korreliert.Es zeigte sich, dass eine distale Flussaufteilung im Verhältnis von 1:1 bei kruralen Ausstromverhältnissen bestand. Im Mittel flossen 65 ml/min nach distal und 70 ml/min nach proximal. Von allen untersuchten Parametern zeigte sich lediglich der erste Impedanzphasenwinkel, welcher den Wellenwiderstand charakterisiert, als statistisch signifikant mit den Offenheitsraten nach 3 Jahren verbunden. Während der Grenzwert für den totalen Abstromwiderstand –40° (p<0,01) betrug, waren es -33° (p<0,05) beim selektiven retrograden und –45° (p<0,01) beim antegraden Ausstrom.