Trasplante hepático experimental en el cerdo con donante a corazón parado. Efecto de diversas modificaciones de la bomba de derivación cardiopulmonar durante la recirculación sobre la viabilidad del injerto hepático.
SUMMARY: "Liver transplantation in pigs from non-heart-beating donors. Effects of different modifications in cardiopulmonary bypass pump during recirculation on viability of liver allograft". TEXT: AIM: To evaluate liver graft viability from non-heart-beating donor (NHBD) pigs after sixty min of warm ischemia by independent modifications during cardiopulmonary bypass. MATERIAL AND METHODS: Pigs weighing 25-35 Kg underwent transplants with an allograft from a NHBD after sixty min of warm ischemia (WI). To determine the effect of every modification on recirculation, six groups were designed for donors: 1) Control Group=CG; n=10): They underwent Recirculation (RC) divided in two parts: 1) Normothermic recirculation at 37ºC for 30 min, 2) Hypothermic recirculation (HR) animals were cooled to 15ºC, and variable pump flow rate (VPFR). 2) High pump flow rate Group (HFG): n=8, 30 min NR at constant pump flow rate (2,4 L/min/m2). 3) Low pump flow rate Group (LFG): n=8, 30 min NR at constant pump flow rate (1,2 L/min/m2). 4) 60 min NR Group: (60NRG): n=8, 60 min NR (VPFR) and HR. 5) No hypothermic recirculation Group (NHR): n=8, 30 min NR (VPFR) without HR. 6) Dobutamine Group (DbtG): n=8, 5?g/Kg/min dobutamine infusion rate during RC. First study: CG, HFG and LFG. Second study: CG and 60NRG, Third study: CG with NHRG. Fourth study: CG with DbtG. ANALYSIS: Survival after five days postransplantation, hemodynamic parameters (pump flow rate, hepatic arterial, portal and total hepatic blood flow rate) and oxygen metabolism parameters (hepatic oxygen extraction ratio, hepatic oxygen delivery and consumption) only during RC. Liver function markers (transaminases, hyaluronic acid clearance and metabolism energetic markers: adenine nucleotides and degradation products). Histological changes were evaluated at fifth day postransplantation. Statistics was performed with non parametric tests. RESULTS/CONCLUSIONS: 1) Pump flow rate determined hepatic blood flow parameters (hepatic artery, Portal vein and total hepatic flow) and modified delivery, consumption and hepatic oxygen extraction ratio. 3) Optimum pump flow ratio must be over 2,4 L/min/m2. 4) Extended NR to 60 min improved hepatocitary, endothelial and energetic function. 5) HR suppression improved hepatocitary and endothelial function. 6) Dobutamine addition during RC increased delivery, consumption and oxygen extraction ratio and recovered hepatocitary, endothelial and energetic metabolism function. 7) Survival rate mean was 60%, and by groups: CG: 80%, NHR: 75%, HFG and DbtG: 62,5%, and LFG: 37,5%.
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Advisor:García-Valdecasas Salgado, Juan Carlos; Valero Castell, Ricard
School:Universitat de Barcelona
Source Type:Master's Thesis
Keywords:cirurgia i especialitats quirúrgiques
Date of Publication:03/02/2009