Abstract:
BACKGROUND:Ischemia-reperfusion injury (IRI) can occur during hepatic surgery and transplantation. IRI causes hepatic mitochondrial and microcirculatory impairment, resulting in acute liver dysfunction and failure. We proposed a novel strategy of regulated hepatic reperfusion (RHR) to reverse the cellular metabolic deficit that incurred during organ ischemia by using a substrate-enriched, oxygen-saturated, and leukocyte-depleted perfusate delivered under regulated reperfusion pressure, temperature, and pH. We investigate the use of RHR in mitigating IRI after a prolonged period of warm ischemia. METHODS:Using a 2-hour liver warm ischemia swine model, 2 methods of liver reperfusion were compared. The control group (n = 6) received conventional reperfusion with unmodified portal venous blood under unregulated reperfusion pressure, temperature, and pH. The experimental group (n = 6) received RHR. We analyzed the effects of RHR on post-reperfusion hemodynamic changes, liver function, and 7-day animal survival. RESULTS:RHR resulted in 100% survival compared with 50% in the control group (p = 0.05). Post-reperfusion syndrome was not observed in the RHR group, but it occurred in 83% of the control group. RHR resulted in a lesser degree of change from baseline serum alanine aminotransferase levels, aspartate aminotransferase, and lactate dehydrogenase after reperfusion compared with the control group. Histopathologic evaluation showed minimal ischemic changes in the RHR group, whereas a considerable degree of coagulative hepatocellular necrosis was observed in the control group. CONCLUSIONS:Regulated hepatic reperfusion mitigates IRI, facilitates liver function recovery, and improves survival after a prolonged period of hepatic warm ischemia. This novel strategy has potential applicability to clinical hepatic surgery and liver transplantation when marginal grafts are used.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Hong JC,Koroleff D,Xia V,Chang CM,Duarte SM,Xu J,Lassman C,Kupiec-Weglinski J,Coito AJ,Busuttil RWdoi
10.1016/j.jamcollsurg.2011.12.010subject
Has Abstractpub_date
2012-04-01 00:00:00pages
505-15; discussion 515-6issue
4eissn
1072-7515issn
1879-1190pii
S1072-7515(11)01326-3journal_volume
214pub_type
杂志文章abstract:BACKGROUND:A minority of liver transplantation (LT) candidates pursue listing at multiple centers to achieve transplantation. The purpose of this study was to assess the characteristics and outcomes of the migrated LT candidates, that is, those who travel to secondary centers seeking LT. STUDY DESIGN:Single-center ret...
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abstract::Transvenous inferior vena cava (IVC) interruption using the Greenfield filter was performed upon 193 patients from January 1982 to December 1988. Placement of a filter in the IVC was indicated for prophylaxis (23.8 percent), contraindication to anticoagulation (22.8 percent), pulmonary embolism despite anticoagulation...
journal_title:Journal of the American College of Surgeons
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doi:
更新日期:1994-02-01 00:00:00
abstract:BACKGROUND:Commonly performed elective gastrointestinal surgical procedures are carried out with low morbidity and mortality in hospitals throughout the United States. Complex operative procedures on the alimentary tract are performed with a relatively low frequency and are associated with higher mortality. Volume and ...
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journal_title:Journal of the American College of Surgeons
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abstract:BACKGROUND:To evaluate whether abdominal aortic aneurysm (AAA) growth in individual patients can be characterized as continuous or discontinuous (staccato). STUDY DESIGN:From 1996 to 2002, 609 patients presented with unruptured AAAs. Of these, 278 underwent prompt repair and 331 were observed. In this study, we includ...
journal_title:Journal of the American College of Surgeons
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更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Frequently, patients present with symptoms after cholecystectomy (pain or discomfort in the upper part of the abdomen, postprandial fullness, bile vomiting, among others). Duodenogastric reflux has been associated with these symptoms in some patients. Therefore, this study was done to investigate this relati...
journal_title:Journal of the American College of Surgeons
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更新日期:1994-08-01 00:00:00
abstract:BACKGROUND:Palliative surgery for advanced cancer patients involves complex decision making. Surgeons with a cancer-focused practice were surveyed to determine the extent to which palliative surgery was currently practiced, to identify ethical dilemmas and barriers they faced in performing palliative surgery, and to ev...
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更新日期:2002-09-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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更新日期:2013-01-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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更新日期:2011-07-01 00:00:00
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abstract:BACKGROUND:This study was undertaken to report our experience with major vascular injuries in gynecologic laparoscopy in order to specify the circumstances under which they occurred, the means of diagnosis, the risk factors, and the means for prevention. STUDY DESIGN:Retrospective case review study. RESULTS:Seventeen...
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更新日期:1994-11-01 00:00:00
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doi:
更新日期:1996-07-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
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更新日期:1997-12-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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更新日期:2006-02-01 00:00:00