Early Vascular Complications Research Articles

Mechanisms of macro-, micro- and ultramicroscopic transformation of bodies in diabetes

The study of structural changes of organs and tissues in the context of diabetes is one of the urgent problems of modern medicine. According to WHO, in all countries of the world the number of patients with diabetes exceeds 175 million. According to an expert estimate of the spread of this disease by 2025 will make about 300 million people. More than 1 million people with diabetes have been officially registered in Ukraine. WHO has recognized the disease as a non-communicable epidemic. The dramatic increase in the prevalence of diabetes requires a detailed study of this problem. It is established that the prevalence of diabetes increases among the population of the countries of the world depending on the region, the level of economic development of the country, gender and age. Thus, according to IDF findings, there is a tendency for the highest prevalence of diabetes among the urban (urban) able-bodied population of developing countries in persons between 40 and 59 years of age, approximately equal in both male and female. The number of patients is increasing, mainly due to patients with type 2 diabetes. Type 2 diabetes (type 2 diabetes mellitus) is a severe progressive chronic disease that is an independent risk factor for heart failure (CH) and cardiovascular complications. In the XXI century. the steady growth of type 2 diabetes and the frequency of its serious consequences is of great concern to the world medical community. It is important that at the time of diagnosis of type 2 diabetes, the prevalence of complications leading to a decline in quality of life, early disability and premature death is already high enough. Despite the presence in the fight against this disease effective drugs, modern technologies, new educational and preventive techniques, mankind loses the fight against diabetes year after year, which leads to disability due to its complications, reducing the life expectancy and quality of life of patients, loss working capacity and premature mortality. Thus, the current prevalence and incidence of diabetes and life-threatening complications suggest that there is a non-communicable diabetes epidemic in the world and in Ukraine in particular. The article represents analysis of work of numerous researchers who studied statistіcal, clinical and morphological aspects of the impact of diabetes on cardiovascular system. Main morphogenetic, morphological and clinical aspects of complications of diabetes, pathologies of microcirculation of patients with diabetes were dedicated, what makes possible to predict and detect on the early stages vascular complications in diabetes and to perform effective prevention and treatment.

Early postoperative mortality in liver transplant recipients involving indications other than hepatocellular carcinoma. A retrospective cohort study

AimsTo analyze the perioperative differences in a consecutive cohort of liver transplant recipients (LTRs) classified according to the indication of transplantation, and assess their impact upon early mortality 90 days after transplantation. DesignA retrospective cohort study was carried out. ScopeA single university hospital. PatientsA total of 892 consecutive adult LTRs were included from January 1995 to December 2017. Recipients with acute liver failure, retransplantation or with grafts from non-brain death donors were excluded. Two cohorts were analyzed according to transplant indication: hepatocellular carcinoma (HCC-LTR) versus non-carcinoma (non-HCC-LTR). Main variables of interestRecipient early mortality was the primary endpoint. The pretransplant recipient and donor characteristics, surgical time data and postoperative complications were analyzed as independent predictors. ResultsThe crude early postoperative mortality rate related to transplant indication was 13.3% in non-HCC-LTR and 6.6% in HCC-LTR (non-adjusted HR=2.12, 95%CI=1.25–3.60; p=0.005). Comparison of the perioperative features between the cohorts revealed multiple differences. Multivariate analysis showed postoperative shock (HR=2.02, 95%CI=1.26–3.24; p=0.003), early graft vascular complications (HR=4.01, 95%CI=2.45–6.56; p<0.001) and multiorgan dysfunction syndrome (HR=18.09, 95%CI=10.70–30.58; p<0.001) to be independent predictors of mortality. There were no differences in early mortality related to transplant indication (adjusted HR=1.60, 95%CI=0.93–2.76; p=0.086). ConclusionsThe crude early postoperative mortality rate in non-HCC-LTR was higher than in HCC-LTR, due to a greater incidence of postoperative complications with an impact upon mortality (shock at admission to intensive care and the development of multiorgan dysfunction syndrome).

Robotic living donor hepatectomy: Is it the future?

Donor liver hepatectomy has always been associated with significant risks and complications affect up to 1/3 of patients. The vast majority are related to large incisions, severe postoperative pain, lung atelectasis, extensive intrabdominal adhesions as well as intraoperative blood loss and biliary injuries. The advent of robotic surgery can improve outcomes through minimally invasive approaches and use of superb technological instruments, but its use for donor hepatectomy is still in infancy. This review summarises its current state and challenges. Review of published literature. Robotic liver surgery offers significant advantages: small access wounds, stable magnified 3-D intraabdominal views, multidimensional instrument articulation. For liver donor resection this allows close individual biliary and vascular dissection, improved haemostasis by ligating vascular pedicles precisely, parenchymal transection facilitated by better views and reduced blood loss. Even in the challenging right donor hepatectomy, a fourth robotic arm allows for identification of accessory veins and venous reconstruction if necessary. Published studies show longer operative time for the robotic population but comparable intraoperative blood loss and similar incidence of early allograft dysfunction, vascular complications (hepatic artery thrombosis, portal vein thrombosis or stenosis), and 1-year liver regeneration and liver function tests. Robotic hepatectomy has the potential to revolutionize living donor liver surgery and to minimize major complications and their associated morbidity. However it is still limited to few highly expert centers and requires extensive operative experience in robotic and liver resections. As exposure to minimally invasive techniques grows, it could become the mainstay of practice in the next decade.

Early protocol computer tomography and endovascular interventions in pancreas transplantation.

Early vascular complications following pancreatic transplantation are not uncommon (3%-8%). Typically, cross-sectional imaging is requested in response to clinical change. We instituted a change in protocol to request imaging pre-emptively to identify patients with thrombotic complications. In 2013, protocol computer tomography angiography (CTA) at days 3-5 and day 10 following pancreas transplantation was introduced. A retrospective analysis of all pancreas transplants performed at our institution from January 2001 to May 2019 was undertaken. A total of 115 patients received pancreas transplants during this time period. A total of 78 received pancreas transplant without routine CTA and 37 patients with the new protocol. Following the change in protocol, we detected a high number of subclinical thromboses (41.7%). There was a significant decrease in invasive intervention for thrombosis (78.6% before vs 30.8% after, p=.02), and graft survival was significantly higher (61.5% before vs 86.1% after, p=.04). There was also a significant reduction in the number of graft failures (all-cause) where thrombosis was present (23.4% before vs 5.6% after, p=.02). Patient survival was unaffected (p=.48). Implementation of early protocol CTA identifies a large number of patients with subclinical graft thromboses that are more amenable to conservative management and significantly reduces the requirement for invasive intervention.

NIRS-based monitoring of kidney graft perfusion.

IntroductionAcute early vascular complications are rare, but serious complications after kidney transplantation. They often result in graft loss. For this reason, shortening the diagnostic process is crucial. Currently, it is standard procedure to monitor renal graft perfusion using Doppler ultrasound (DU). With respect to acute vascular complications, the main disadvantage of this type of examination is its periodicity. It would be of great benefit if graft blood perfusion could be monitored continuously during the early postoperative period. It appears evident that a well-designed near infrared spectroscopy (NIRS) monitoring system could prove very useful during the early post-transplantation period. Its role in the immediate diagnosis of vascular complications could result in a significant increase in graft salvage, thus improving the patient’s overall quality of life and lowering morbidity and mortality for renal graft recipients. The aim of this study was to design, construct and test such a monitoring system.Materials and methodsWe designed a rough NIRS-based system prototype and prepared a two-stage laboratory experiment based on a laboratory pig model. In the first stage, a total of 10 animals were used to verify and optimize the technical aspects and functionality of the prototype sensor by testing it on the animal kidneys in-vivo. As a result of these tests, a more specific prototype was designed. During the second stage, we prepared a unique laboratory model of a pig kidney autotransplantation and tested the system for long-term functionality on a group of 20 animals. Overall sensitivity and specificity were calculated, and a final prototype was prepared and completed with its own analytic software and chassis.ResultsWe designed and constructed a NIRS-based system for kidney graft perfusion monitoring. The measurement system provided reliable performance and 100% sensitivity when detecting acute diminished blood perfusion of the transplanted kidneys in laboratory conditions.ConclusionThe system appears to be a useful tool for diagnosing diminished blood perfusion of kidney transplants during the early postoperative period. However, further testing is still required. We believe that applying our method in current human transplantation medicine is feasible, and we are confident that our prototype is ready for human testing.

Postoperative bacteremia is associated with early vascular complications in pediatric liver transplant recipients with biliary atresia

Postoperative bacteremia is associated with early vascular complications in pediatric liver transplant recipients with biliary atresia

Costs Associated With Early Vascular and Biliary Complications in Liver-Transplanted Patients in a Hospital in Antioquia, Colombia 2019: A Case Series

ObjectivesVascular and biliary complications associated with liver transplants involve high morbidity and mortality as well as cost overrun for health systems. Efforts to prioritize their prevention require not only clinical information but also information on costs that reflect the economic burden on health systems. The objective of this study was to describe cost overrun incurred from early vascular and biliary complications after liver transplant. MethodsThis cases series included liver transplant patients treated at the San Vicente Foundation University Hospital, Rionegro, Antioquia, from January 1, 2013, to December 31, 2018. All liver transplant patients treated during the above period were included; the absence of clinical records on the variables of interest was considered the exclusion criterion. A probabilistic analysis of patient cost was performed. Monte Carlo simulations as well as a 1-way sensitivity analysis per transplant cost component were performed. ResultsRecords from 154 patients were assessed. The average patient age was 56.9 (SD 10.9) years; 42.9% of patients were women. Of all, 36.4% patients were classified as Child C, and the average Model for End-Stage Liver Disease score was 19.6. The average cost for patients without complications was $27 834.82, whereas that for patients with early vascular complications was $36 747.83 and for those with early biliary complications was $38 523.74. ConclusionEarly vascular and biliary complications after liver transplant increase healthcare costs, with the increase being significant in patients with biliary complications.

Vascular Complications of Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Regression Analysis

Perform a systematic review and meta-analysis of vascular complications associated with extracorporeal membrane oxygenation and identify prognostic and predictive factors. Systematic search for publications reporting vascular complications on extracorporeal membrane oxygenation, published from 1972 to January 31, 2020, was conducted via PubMed, Scopus, and Embase. Of 4,076 references screened, 47 studies with 6,583 patients were included in final analyses. Studies with fewer than 10 patients were excluded. Relevant data, including demographics, comorbidities, extracorporeal membrane oxygenation and cannulation characteristics, occurrence rates of early and late vascular complications, patient outcomes, and use of distal perfusion cannula, were extracted from selected articles into an excel sheet specifically designed for this review. Random-effects meta-analyses and meta-regression analyses were undertaken. Overall pooled estimate of vascular complications in our meta-analysis was 29.5% (95% CI, 23.6-35.9%). Two-thousand three-hundred forty-seven vascular complications in 6,124 venoarterial extracorporeal membrane oxygenation patients compared with 95 in 459 venovenous extracorporeal membrane oxygenation patients (odds ratio, 2.35; 95% CI, 1.87-2.96; p < 0.0001) were analyzed. Successful weaning off extracorporeal membrane oxygenation occurred in 60.6% of pooled patients; 46.2% were eventually discharged. Pooled prevalences of vascular complications like significant bleeding, limb ischemia, and cannula site bleeding were 15.4% (95% CI, 8.6-23.7%), 12.6% (95% CI, 10.0-15.5%), and 12.6% (95% CI, 9.6-18.5%), respectively. Meta-analysis showed that the use of distal perfusion cannula was associated with lower odds of limb ischemia (odds ratio, 1.93; 95% CI, 1.17-2.47; p = 0.03) Meta-regression showed that male sex, smoking, advanced age, and comorbidities contributed to higher in-hospital mortality, while distal perfusion cannula was protective. Nearly a third of patients on extracorporeal membrane oxygenation develop vascular complications; elderly males with comorbidities appear vulnerable. The use of distal perfusion cannulas caused significant reduction in limb ischemia and mortality.

Neutrophil Extracellular Traps Generation Relates with Early Stage and Vascular Complications in Systemic Sclerosis.

Systemic sclerosis (SSc) is a systemic disease characterized by a great clinical and immunological heterogeneity whose pathophysiology is still being unraveled. Recently, innate immunity has been proposed to participate to the pathogenesis of SSc. In this study, we investigated the release of neutrophil extracellular traps (NETs) according to patient phenotype. Polymorphonuclear neutrophils (PMN) from 34 SSc patients and 26 healthy controls were stimulated by serum from SSc or healthy subject. NETs were visualized using epifluorescence microscope after DNA, myeloperoxidase, and Histone H3 tagging. Area of NETs were quantified using an original macro running in ImageJ® software. PMN from SSc patients were significantly more prone to releasing NETs than control PMN after autologous stimulation. PMN from patients with severe vascular complications (pulmonary arterial hypertension, digital ulcers) produced more NETs than PMN from other SSc patients and their aberrant NET production appeared to be sustained over time. In patients with pulmonary interstitial disease or extensive cutaneous fibrosis, NET production was high at an early stage of the disease before progressively decreasing. Both serum factors and PMN activation status were involved in the enhanced production of NETs in SSc. Consequently, neutrophils and especially NETosis represent new physiopathological and therapeutic fields in SSc.

Outcomes of Transcatheter Aortic Valve Implantation in Patients Receiving Chronic Systemic Corticosteroid Treatment

The aim of this study was to describe the effects of chronic systemic corticosteroid treatment (SCT) on early and late outcomes after transcatheter aortic valve implantation (TAVI). From October 2006 to November 2018, 1,299 patients underwent TAVI in our institution. Among them, 48 (3.7%) received chronic SCT at the time of procedure (SCT group). They were more frequently women (p = 0.08) and needed more often dialysis (p = 0.002). All other baseline characteristics were similar between both groups. At 30 days, there was no difference on mortality. However, after adjustment, the SCT group had more major vascular complications: 16.7% versus 7.4%, hazard ratio (HR) 2.52 (95% confidence interval [CI] 1.14 to 5.9, p = 0.023), major or life-threatening bleedings: 22.9% versus 12.4%, HR 2.02 (95% CI 1.00 to 4.08, p = 0.05), and tamponades: 8.3% versus 2.4%, HR 4.05 (95% CI 1.35 to 12.15, p <0.001) than the non-SCT group. One-year all-cause mortality was significantly higher in the SCT than in the non-SCT group (37.5% vs 12.5%, p <0.0001). Multivariate analysis confirmed that SCT use was an independent predictor of 1-year mortality (HR 2.29, 95% CI 1.16 to 4.50, p = 0.017). In conclusion, chronic use of SCT significantly increases the rates of early vascular complications, major or life-threatening bleedings and tamponade and is an independent predictor of 1-year all-cause mortality after TAVI.

The Effects of Mat Pilates Training on Vascular Function and Body Fatness in Obese Young Women With Elevated Blood Pressure.

Effective nonpharmacological interventions targeting the enhancement of vascular function and decline of body fatness (BF) in obese individuals are indispensable for the prevention of hypertension and cardiovascular events in young adults. Mat Pilates training (MPT) has gained significant popularity worldwide, yet its effects on vascular function and body composition are understudied. We examined the effects of MPT on vascular function and BF in young obese women with elevated blood pressure (BP). Twenty-eight young obese women with elevated BP were randomized to an MPT (n = 14) or a nonexercising control (CON, n = 14) group for 12 weeks. Systemic arterial stiffness (brachial-ankle pulse wave velocity (baPWV)), brachial and aortic BP, wave reflection (augmentation index (AIx)), plasma nitric oxide (NO) levels, and BF percentage (BF%) were assessed before and after 12 weeks. MPT significantly reduced (P ˂ 0.05) baPWV (-0.7 ± 0.2 m/s), AIx (-4 ± 1%), brachial systolic BP (-5 ± 1 mm Hg), aortic systolic BP (-6 ± 1 mm Hg), and BF% (-2 ± 1%), while significantly increasing plasma NO (6 ± 2 µM) (P ˂ 0.05) compared with CON. MPT improved systemic arterial stiffness, aortic BP, wave reflection, circulating plasma NO, and BF% in young obese women with elevated BP. MPT may be an effective intervention for the improvement of vascular function and BF in young obese women with elevated BP, a population at risk for hypertension and early vascular complications. Trial Number NCT03907384.

Advanced Glycated End Products or High Glucose/Palmitate treatment modulate TREM‐1, Arginase and Nitric Oxide Levels in Macrophages.

Arginase is ureohydrolase enzyme that has essential actions in the body, most importantly in the urea cycle. Though, increased arginase activity has been demonstrated to contribute to vascular endothelial dysfunction (VED) in a number of disease/pathophysiological conditions, such as diabetes, aging, atherosclerosis and hypertension. Enhanced arginase activity/expression results in reduced availability of L‐arginine for nitric oxide synthase (NOS) and decrease NO production. Vascular dysfunction is a common characteristic of the early vascular complications of diabetes. Inflammation has been shown to be a potent modulator of vascular dysfunction in diabetes. we have previously found that increased inflammatory mediators in diabetic conditions seem to affect arginase levels as well. we hypothesise that advanced glycated end products (AGE), which get elevated in diabetes, can stimulate expression of Triggering Receptor Expressed On Myeloid Cells (TREM‐1). TREM‐1 has a key role in vascular endothelial activation, inflammation and dysfunction. Also AGEs cause an increase in arginase expression and activity in macrophages. Additionally, treating macrophages with high glucose/palmitate (HG/PA); which represents a model of high fat‐high sugar intake; has also resulted in upregulation of TREM‐1 and arginase 2 levels in macrophages. We also looked at NO levels produced under different conditions and have seen that both AGE or HG/PA cause an increase in NO levels from macrophages. Our studies indicate that there is a cross talk between TREM‐1 receptor and arginase under different diabetic conditions. Our earlier findings indicate the importance of controlling levels of arginase in diabetes to prevent vascular dysfunction. Regulating inflammatory receptors such as TREM‐1 can also have a powerful impact on controlling vascular dysfunction and complications in diabetes.

Early postoperative mortality in liver transplant recipients involving indications other than hepatocellular carcinoma. A retrospective cohort study

To analyze the perioperative differences in a consecutive cohort of liver transplant recipients (LTRs) classified according to the indication of transplantation, and assess their impact upon early mortality 90 days after transplantation. A retrospective cohort study was carried out. A single university hospital. A total of 892 consecutive adult LTRs were included from January 1995 to December 2017. Recipients with acute liver failure, retransplantation or with grafts from non-brain death donors were excluded. Two cohorts were analyzed according to transplant indication: hepatocellular carcinoma (HCC-LTR) versus non-carcinoma (non-HCC-LTR). Recipient early mortality was the primary endpoint. The pretransplant recipient and donor characteristics, surgical time data and postoperative complications were analyzed as independent predictors. The crude early postoperative mortality rate related to transplant indication was 13.3% in non-HCC-LTR and 6.6% in HCC-LTR (non-adjusted HR=2.12, 95%CI=1.25-3.60; p=0.005). Comparison of the perioperative features between the cohorts revealed multiple differences. Multivariate analysis showed postoperative shock (HR=2.02, 95%CI=1.26-3.24; p=0.003), early graft vascular complications (HR=4.01, 95%CI=2.45-6.56; p<0.001) and multiorgan dysfunction syndrome (HR=18.09, 95%CI=10.70-30.58; p<0.001) to be independent predictors of mortality. There were no differences in early mortality related to transplant indication (adjusted HR=1.60, 95%CI=0.93-2.76; p=0.086). The crude early postoperative mortality rate in non-HCC-LTR was higher than in HCC-LTR, due to a greater incidence of postoperative complications with an impact upon mortality (shock at admission to intensive care and the development of multiorgan dysfunction syndrome).

Case Report on Pseudoaneurysm of Brachial Artery: A Rare Complication of Paediatric Supracondylar Humerus Fracture Pinning

Pseudoaneurysm (PA) of the brachial artery in pediatric supracondylar humerus fracture who have undergone closed reduction and percutaneous pinning is a rare complication. A few cases have been reported in medical literature. This case report sheds some insight into early identification and management outcome of such complication. Rapidly progressive swelling in antecubital fossa in cases of supracondylar fracture who have undergone pinning should arouse suspicion of vascular lesion. It should be timely intervened. Surgical intervention of pseudoaneurysm with reversed saphenous venous graft has shown to have no early vascular complication.

Case Report on Pseudoaneurysm of Brachial Artery: A Rare Complication of Paediatric Supracondylar Humerus Fracture Pinning

Pseudoaneurysm (PA) of the brachial artery in pediatric supracondylar humerus fracture who have undergone closed reduction and percutaneous pinning is a rare complication. A few cases have been reported in medical literature. This case report sheds some insight into early identification and management outcome of such complication. Rapidly progressive swelling in antecubital fossa in cases of supracondylar fracture who have undergone pinning should arouse suspicion of vascular lesion. It should be timely intervened. Surgical intervention of pseudoaneurysm with reversed saphenous venous graft has shown to have no early vascular complication.

Risk Factors of Early Kidney Graft Transplantectomy

BackgroundKidney allograft explant in the first month after transplant is a major concern for medicosurgical teams specialized in kidney transplantation and unacceptable graft loss in the current shortage. The aim of our study was to evaluate the risk factors of early kidney graft explant. MethodsWe retrospectively analyzed all adult kidney transplantations performed at our center from January 2006 to December 2011. Recipient, donor, and transplant characteristics were collected, as well as operating data and early postoperative complications. Univariate and multivariate logistic regression models were used to determine risk factors of early renal allograft explant. ResultsFrom a total of 707 kidney transplantations, 28 transplantectomies were performed in the first month following transplantation (3.96%). The average delay in days ± SD was 7.6 ± 10. Eighty-six percent of transplantectomies were due to vascular complications. In multivariate analysis, obesity (odds ratio [OR] = 9.6; 95% confidence interval [CI], 1.63-56.5; P = .0007), range of transplantation (OR = 36.89; 95%CI, 5.5-245; P = .0006), intraoperative complications (OR = 3.99; 95%CI, 1.22-13; P = .026), and early postoperative vascular complications (OR = 85.15; 95%CI, 23.6-306; P < .0001) were independent risk factors. Neither donors nor graft characteristics were significant. ConclusionsEarly renal graft transplantectomies are rare but account for 50% of renal graft loss in the first year. Because obesity, perioperative complications, and early vascular complications are independent factors associated with early transplantectomies, their prevention should be based on meticulous surgery during organ procurement, implantation of the kidney, and on the rehabilitation of future recipients.

Importance of Early Diagnosis and Care in Knee Dislocations Associated with Vascular Injuries

Arterial injury secondary to acute knee dislocation (KD) is a rare but devastative complication. The aim of this study is to evaluate functional sequelae and factors of poor prognosis. A retrospective monocentric series of consecutive KD with acute ischemia by popliteal artery injury was analyzed between 2005 and 2017. The main outcome was the amputation rate. Sixteen dislocations were included. Nine (56%) were due to public road accidents, 5 (31%) were due to falls from height, and 2 (13%) were due to sports injuries. Dislocation had occurred in the posterior location in 8 (50%) cases. Regarding arterial injury, there were 7 (44%) ruptures, 7 (44%) dissections, and 2 (13%) isolated thromboses. Eleven (69%) KDs with vascular trauma were associated with signs of acute ischemia. Revascularization was achieved by anatomical venous bypass in 14 (88%), resection and direct anastomosis in one (6%), and isolated thrombectomy in one (6%). Median time to surgery (time between trauma and vascular repair) was 7hours (3.25-60.92hours). Primary revascularization was performed in 12 (75%) cases. In three cases (19%), orthopedic reduction and stabilization were performed first. In one case, (6%) three-step management with vascular shunt at first, then with knee stabilization, and finally vascular bypass was carried out. Stabilization was achieved by using an external fixator in 13 (82%) cases, by open reduction and internal fixation in one case (6%), by ligamentoplasty in one (6%), and by using a long leg cast in one (6%). Fasciotomy was required in 12 (75%) cases. Two patients had early vascular complications, and 2 had early systemic complications. Three secondary transfemoral amputations were performed. Median follow-up duration was 23months. No secondary amputation was recorded. At the end of follow-up, functional outcomes were evaluated using the Oxford Knee Score (OKS). The median OKS was 30 versus the pretrauma median OKS of 47 (P<0.00028). No risk factor associated with limb amputation has been highlighted. Analysis of these results provided indications for therapeutic management of this condition. This study shows poor functional outcomes because of severity of vascular lesion in patients with orthopedic trauma but with healthy arteries.

A Survival Analysis of Living Donor Kidney Transplant

BackgroundSuperior patient and graft survival rates have been attributed to living donor kidney transplant (LDKT) when compared to deceased donor transplantation. The aim of this study was to assess graft survival in a population of LDKT in the last 14 years and the potential impact of some clinical features. MethodsA retrospective observational study was conducted, reviewing the records of all patients undergoing LDKT in one center from January 1, 2004, to December 31, 2017. Survival data were evaluated by Kaplan-Meier, log rank test, and Cox regression. ResultsTwo hundred seventy-seven LDKT were performed. The median follow-up time was 4 (0–13) years. Graft loss was observed in 9% of patients; 4 patients died. The overall survival was 97% at year 1, 94% at year 5, and 83% at years 10 and 13. We found a significantly worse graft survival in patients with early vascular complications that required surgical intervention (P = .00) ≥3 HLA MM (P = .01), ≥1 HLA-DR MM (P = .04) and female recipients (P = .01). The negative impact of ≥1 HLA-B MM on survival was borderline (P = .05). After excluding early graft losses secondary to vascular events, ≥1 HLA-A MM and rejection have also implicated a negative impact on survival (P = .04 and .01, respectively). In the multivariate analysis, these variables were still related to inferior survival. ConclusionsWe observed a good overall graft survival (>80% after 13 years). Possible factors related to poor outcomes suggested by this study were early vascular complications; HLA mismatches; rejection; and, with less certainty, female recipients.

Outcome of the use of paediatric donor livers in adult recipients: A single Chinese centre experience

Paediatric liver allografts sometimes are allocated to adult recipients when there are no suitable paediatric recipients on the waiting list. However, debate exits regarding the reported outcomes of liver transplants using such small grafts. Records from adult patients undergoing liver transplantation between February 2010 and January 2016 who received whole grafts from paediatric (≤ 13 years) donors or ideal deceased adult (18-35 years) donors were reviewed. Patient and graft survival, post-transplant liver function, and complications between the two groups were compared. The baseline characteristics were comparable, except that the paediatric donor allografts had smaller size. The 3-month, 1-year, and 3-year rates of patient survival were 91.3%, 85.2%, and 85.2% in the paediatric donor group and 93.4%, 88.9%, and 85.0% in the adult donor group (P = 0.947), respectively. One patient receiving a paediatric allograft developed small-for-size liver syndrome post-transplantation. There was no difference in primary non-function, early allograft dysfunction, biliary complications, vascular complications, or infection between the two groups. Our study indicates that using paediatric donor livers in well-selected adult recipients is a safe procedure, considering there was no suitable paediatric recipient. However, the risk of portal hyperperfusion should be considered in clinical cases such as size-mismatched transplants.

Interleukin 6 at reperfusion: A potent predictor of hepatic and extrahepatic early complications after liver transplantation

Ischemia-reperfusion injury impacts early liver graft function. Interleukin 6 (IL-6) as early as at reperfusion has shown to predict in-hospital complications, but its impact on vascular complications and long-term outcomes is not ascertained. A retrospective study was conducted on all consecutive patients transplanted during a 6-year period to define significant early systemic inflammatory response (ESIR). The main end-point was 3-year graft survival. Significant ESIR was defined according to IL-6 level at reperfusion on an exploratory set of 121 patients and validated on an independent cohort (n=153). Significant ESIR was defined as IL-6 at reperfusion >1000ng/mL in the exploratory cohort. Three-year graft and overall survival were lower in patients with ESIR in the determination set (P=0.001 and 0.045, respectively). This was confirmed in the validation set (P=0.045 and 0.027). In patients with high cytolysis, IL-6 identified patients at risk for arterial thrombosis. The main determinants for IL-6 level were intragraft lactate level, cold ischemia time, and anhepatic phase duration (P=0.005). IL-6 level independently predicted graft survival (P=0.0003). IL-6 at reperfusion is a valid biomarker to predict long-term survival. Furthermore, it helps the interpretation of cytolysis in the prediction of early vascular complications.