The Experts below are selected from a list of 312 Experts worldwide ranked by ideXlab platform

Ian D. Mcgilvray - One of the best experts on this subject based on the ideXlab platform.

  • In situ hypothermic Liver Preservation during radical Liver resection with major vascular reconstruction.
    The British journal of surgery, 2009
    Co-Authors: D. Dubay, Steven Gallinger, Laura Hawryluck, Carol J. Swallow, Stuart A. Mccluskey, Ian D. Mcgilvray
    Abstract:

    Background: The in situ hypothermic Liver Preservation technique may allow a more aggressive approach to tumours of the caval confluence and/or all three hepatic veins, which would otherwise be deemed irresectable. Methods: All descriptive data regarding patient demographics, operative characteristics, perioperative complications and outcomes of nine patients in whom this technique was used were collected prospectively. Results: Seven patients underwent Liver trisegmentectomy and two had primary retrohepatic venal caval resection. Total hepatic vascular occlusion with in situ hypothermic Liver Preservation was used for venous reconstruction in all patients. The vena cava was reconstructed with prosthetic graft in seven patients. All main hepatic veins were reconstructed in the seven Liver resections. In situ hypothermic Liver Preservation was well tolerated as evidenced by preserved hepatic synthetic function early after operation. One patient died 66 days after surgery. There were two recurrences after a median follow-up of 14 (range 2–33) months; local recurrence was identified in one patient after 4 months and distant metastasis in another after 8 months. Conclusion: The in situ hypothermic Liver Preservation technique appears to be a useful adjunct to radical hepatobiliary tumour excision procedures that require total hepatic vascular exclusion and major vascular reconstruction. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Carlos O. Esquivel - One of the best experts on this subject based on the ideXlab platform.

  • Significance of terminal rinse for rat Liver Preservation.
    Transplantation, 1993
    Co-Authors: Egawa H, Carlos O. Esquivel, Richard Garcia Kennedy, Geoffrey M. Collins
    Abstract:

    A terminal rinse (TR) is standard practice in Liver Preservation with University of Wisconsin solution (UW) to avoid a potassium load. The fact that sodium lactobionate sucrose solution (SLS) is an effective organ Preservation solution with a low potassium provided an opportunity to evaluate rat Liver Preservation without the TR step. Its importance was investigated in 122 rat Liver Preservation experiments. In study 1, UW and a hydroxyethyl starch-free, modified UW (UWm) were used for 20-hr Liver Preservation followed by either no TR or Ringer's lactate TR. The 1-week survival was: UW-TR, 2/14; UW-no TR, 1/6; UWm-TR, 0/6; UWm-no TR, 5/5 (P < 0.01). In study 2, Livers were stored for 30 hr in SLS, UW, UWm, and UWm + chlorpromazine 5 mg/L, all without a TR. Nine of 11 rats survived 7 days after SLS, but there were no survivors in the other groups (P < 0.05). Study 3 compared no TR with TR with SLS, Ringer's lactate (RL), or a modified Carolina rinse (CRm) after 30-hr SLS Preservation. Survival, serum aspartate aminotransferase and alanine aminotransferase, and histology were assessed. One-week survival of 9/11 rats in no TR was significantly better than in the other groups (3/14 in TR-SLS, 0/8 in TR-RL, and 0/14 in TR-CRm, P < 0.01). The values of aspartate aminotransferase (mean +/- SE) 3 hr after transplantation were 1862 +/- 439 U/L, 3334 +/- 817 U/L, 6591 +/- 1944 U/L, and 7028 +/- 1704 U/L, respectively, in no TR, TR-SLS, TR-RL, and TR-CRm. There were significant differences both in aspartate aminotransferase and alanine aminotransferase between no-TR and each of TR-RL and TR-CRm (P < 0.05). Liver specimens from rats killed 3 hr after OLT showed only mild injury in the no TR group and severe injury in the remaining groups. We conclude that a terminal rinse is harmful in rat Liver Preservation.

  • Calcium antagonists in sodium lactobionate sucrose solution for rat Liver Preservation.
    Transplantation, 1992
    Co-Authors: Yukihiko Tokunaga, Geoffrey M. Collins, Carlos O. Esquivel
    Abstract:

    The effects of the calcium antagonists, chlorpromazine (CPZ), nisoldipine (NIS), trifluoperazine (TFP), and nicardipine (NIC) were compared in rat Livers following either 20- or 30-hr ice storage in sodium lactobionate sucrose solution (SLS). Survivals beyond 7 days after orthotopic Liver transplantation following 20-hr cold storage were 1/14 in the University of Wisconsin solution, 4/14 in SLS, 4/8 in UW+CPZ, 7/8 in SLS+CPZ. Survivals beyond 7 days after OLT following 30-hr cold storage were 3/8 in SLS+CPZ, 3/8 in SLS+NIS, 2/8 in SLS+TFP, 0/8 in SLS+NIC, and 0/8 in SLS alone. Survival rates were significantly (P less than 0.05) better in both SLS+CPZ and SLS+NIS than in UW and SLS alone. The effluent lactate dehydrogenase (LDH) levels and pH changes were measured at the time of OLT. After 20 hr, LDH levels were 525 +/- 78 IU/L (mean +/- SEM) in UW, 492 +/- 44 in SLS, 322 +/- 35 in UW+CPZ, and 290 +/- 39 in SLS+CPZ. After 30 hr, LDH values were 416 +/- 40 in SLS+CPZ, 450 +/- 25 in SLS+NIS, 448 +/- 21 in SLS+TFP, 573 +/- 18 in SLS+NIC, and 614 +/- 68 in SLS. The LDH levels for SLS+CPZ and SLS+NIS were significantly lower than those of SLS and UW (P less than 0.01). The pH changes in the effluent were significantly less in both the CPZ and NIS groups (P less than 0.01). This study demonstrated improved Liver Preservation by the use of a simplified colloid-free lactobionate solution containing sodium as the principal cation. The addition of CPZ or NIS to the solution demonstrated the same potency for significant improvement in efficacy of this solution, while NIC was ineffective.

Yukihiko Tokunaga - One of the best experts on this subject based on the ideXlab platform.

  • Calcium antagonists in sodium lactobionate sucrose solution for rat Liver Preservation.
    Transplantation, 1992
    Co-Authors: Yukihiko Tokunaga, Geoffrey M. Collins, Carlos O. Esquivel
    Abstract:

    The effects of the calcium antagonists, chlorpromazine (CPZ), nisoldipine (NIS), trifluoperazine (TFP), and nicardipine (NIC) were compared in rat Livers following either 20- or 30-hr ice storage in sodium lactobionate sucrose solution (SLS). Survivals beyond 7 days after orthotopic Liver transplantation following 20-hr cold storage were 1/14 in the University of Wisconsin solution, 4/14 in SLS, 4/8 in UW+CPZ, 7/8 in SLS+CPZ. Survivals beyond 7 days after OLT following 30-hr cold storage were 3/8 in SLS+CPZ, 3/8 in SLS+NIS, 2/8 in SLS+TFP, 0/8 in SLS+NIC, and 0/8 in SLS alone. Survival rates were significantly (P less than 0.05) better in both SLS+CPZ and SLS+NIS than in UW and SLS alone. The effluent lactate dehydrogenase (LDH) levels and pH changes were measured at the time of OLT. After 20 hr, LDH levels were 525 +/- 78 IU/L (mean +/- SEM) in UW, 492 +/- 44 in SLS, 322 +/- 35 in UW+CPZ, and 290 +/- 39 in SLS+CPZ. After 30 hr, LDH values were 416 +/- 40 in SLS+CPZ, 450 +/- 25 in SLS+NIS, 448 +/- 21 in SLS+TFP, 573 +/- 18 in SLS+NIC, and 614 +/- 68 in SLS. The LDH levels for SLS+CPZ and SLS+NIS were significantly lower than those of SLS and UW (P less than 0.01). The pH changes in the effluent were significantly less in both the CPZ and NIS groups (P less than 0.01). This study demonstrated improved Liver Preservation by the use of a simplified colloid-free lactobionate solution containing sodium as the principal cation. The addition of CPZ or NIS to the solution demonstrated the same potency for significant improvement in efficacy of this solution, while NIC was ineffective.

  • Successful 20-hour rat Liver Preservation with chlorpromazine in sodium lactobionate sucrose solution.
    Surgery, 1991
    Co-Authors: Yukihiko Tokunaga, Waldo Concepcion, Paul Nakazato
    Abstract:

    We investigated the effect of the addition of chlorpromazine to a new, simplified organ Preservation solution, sodium lactobionate sucrose (SLS), for 20-hour hypothermic rat Liver Preservation. Survival beyond 7 days after orthotopic transplantation of the stored Liver was eight of eight rats in control groups (immediate transplantation, less than 1-hour Preservation), one of 14 rats with the University of Wisconsin (UW) solution, four of 14 rats with SLS, seven of eight rats with SLS + chlorpromazine, 1 mg/L, and seven of eight rats with SLS + chlorpromazine, 10 mg/L. The differences is survival between UW and SLS and between SLS and SLS + chlorpromazine were significant (p less than 0.05). Lactic dehydrogenase levels in the effluent after reflushing through the portal vein at the time of transplantation were 145 +/- 20 IU/L (mean +/- SEM) in the controls, 525 +/- 78 IU/L in UW, 492 +/- 44 IU/L in SLS, 290 +/- 39 IU/L in SLS + chlorpromazine, 1 mg/L, 290 +/- 11 IU/L in SLS + chlorpromazine, 10 mg/L. The values for the SLS + chlorpromazine were significantly lower than for SLS and UW (p less than 0.05). The pH of the effluent was 7.10 +/- 0.10 in controls, 6.42 +/- 0.12 in UW, 6.64 +/- 0.18 in SLS, and 7.07 +/- 0.02 in SLS + chlorpromazine, 1 mg/L and 10 mg/L. The pH drop was significantly greater in the groups without chlorpromazine (p less than 0.01). This study shows that superior rat Liver Preservation was achieved with a simplified lactobionate solution containing sodium as the principal cation, sucrose in place of raffinose, and omitting the colloid and several of the other UW components. The addition of low concentrations of chlorpromazine further enhanced the effectiveness of this solution, without the need for donor pretreatment.

Darius F. Mirza - One of the best experts on this subject based on the ideXlab platform.

  • Ex-situ Liver Preservation with machine Preservation.
    Current opinion in organ transplantation, 2021
    Co-Authors: Hanns Lembach Jahnsen, Hynek Mergental, M. Thamara P. R. Perera, Darius F. Mirza
    Abstract:

    PURPOSE OF REVIEW To summarize key studies in Liver Preservation published over the last 3 years and evaluate benefits and limitations of the different perfusion techniques. Selected experimental applications that may be translated to the clinical use will be also discussed. RECENT FINDINGS Normothermic machine perfusion (NMP) has transitioned into clinical practice. Viability assessment is a reliable tool for clinical decision-making, and safety of the back-to-base approach has facilitated adoption of the technology. Data supporting well tolerated use of declined Livers after NMP and new protocols selecting complex recipients aim to improve access to suitable organs. Hypothermic machine perfusion (HMP) is showing promising clinical results by decreasing biliary complications in recipients' receiving organs donated after circulatory death (DCD) and improving early graft function in extended criteria organs. Long-term data of HMP on DCD Livers shows improved graft survival over standard SCS. Novel approaches utilizing sequential HMP--NMP or ischaemia-free Preservation aim to improve outcomes of extended criteria organs. SUMMARY Machine perfusion for organ transplantation has become an established technique but the field is rapidly evolving. Ongoing research focuses on evaluation of the intervention efficacy and finding optimal indications to use each perfusion strategy according to graft type and clinical scenario.

  • normothermic ex situ Liver Preservation the new gold standard
    Current Opinion in Organ Transplantation, 2017
    Co-Authors: Richard W Laing, Hynek Mergental, Darius F. Mirza
    Abstract:

    Purpose of reviewNormothermic machine perfusion of the Liver (NMP-L) is a novel technology recently introduced into the practice of Liver transplantation. This review recapitulates benefits of normothermic perfusion over conventional static cold storage and summarizes recent publications in this are

Kiyohiko Dohi - One of the best experts on this subject based on the ideXlab platform.

  • Synergistic effects of nafamostat mesilate rinse and Kupffer cell blockade for rat Liver Preservation
    Transplant International, 1996
    Co-Authors: Hideki Ohdan, Ryo Sumimoto, Takashi Urushihara, Hisao Ito, Yasuhiko Fukuda, Toshimasa Asahara, Kiyohiko Dohi
    Abstract:

    We investigated the efficacy of a new rinse solution containing nafamostat mesilate (NM) (a serine protease inhibitor) for Liver Preservation with modulation of Kupffer cell function. Orthotopic Liver transplantation (OLT) was performed in male Lewis rats after 24 h of cold storage in University of Wisconsin organ Preservation solution. After OLT, survival was determined, together with assays of blood chemistry, tissue NM metabolites, and histology 3 h after OLT. NM rinse was found to have a cytoprotective effect on Liver parenchymal cells, based on enzyme data showing that NM rinse reduced the release of serum alanine aminotransferase significantly in comparison with saline rinse (P < 0.05). However, the effect was not sufficient to improve the survival rate. In contrast, when the donor was treated with gadolinium chloride 24–30 h before graft harvest, NM rinse improved the survival rate to around 80% compared with 25% for saline. The assay of NM metabolites in grafted Liver tissue showed that pretreatment of the donor rats with GdCl3 delayed the degeneration of NM in the Liver tissue. These data demonstrate that NM rinse and Kupffer cell blockade exert synergistic effects, leading to increased survival after cold-preserved Liver transplantation.

  • Successful 48-h Liver Preservation by controlling nutritional status of donor and recipient.
    Transplant International, 1994
    Co-Authors: Ryo Sumimoto, James H. Southard, Kiyohiko Dohi, Yasuhiko Fukuda, Hisashi Oshiro, L. Gambiez, Folkert O. Belzer
    Abstract:

    The nutritional status of the donor has been shown to affect the outcome of Liver transplantation in the rat. It has been proposed that this may be due to inhibition of Kupffer cell induced injury to the reperfused organ, which leads to an inflammatory type response. In this study we investigated how altering the nutritional status of the recipient affects the outcome of Liver transplantation after Preservation of the Liver for 44 or 48 h in the University of Wisconsin (UW) solution. The nutritional status of the rats was altered by either fasting or by feeding an essential fatty acid free diet (EFAD) for 2 months. This type of diet has been shown to reduce significantly the inflammatory response in rats. Survival after 44-h Preservation of Livers from fed donors (fed a standard laboratory diet) transplanted to fed recipients was 29% (2/7) but increased to 80% (4/5) when the recipient was fed the EFAD diet. After 48-h Preservation, there were no survivors under either of these two dietary combinations. However, survival was 100% after 48-h Preservation if the donor had been fasted for 4 days and the recipient was fed the EFAD. These results showed that the nutritional status of the donor and recipient are important factors in the outcome of Liver transplantation. How nutritional factors affect Liver Preservation and transplantation are not clear but may be related to the inflammatory response regulated by Kupffer cells and circulating neutrophils in the Liver, both of which are influenced by the diet of the animal.

  • An examination of the effects of solutions containing histidine and lactobionate for heart, pancreas, and Liver Preservation in the rat.
    Transplantation, 1992
    Co-Authors: Ryo Sumimoto, Kiyohiko Dohi, Takashi Urushihara, Neville V. Jamieson, Hisao Ito, Kazuo Sumimoto, Yasuhiko Fukuda
    Abstract:

    Fifty-five rat pancreas transplants, 18 rat heart transplants, and 41 rat Liver transplants were performed using standard UW solution, the new HL solution (HL-I), or a modified HL solution (HL-II). Storage times of 18 hr were used in the heart Preservation experiments, 24 hr in the Liver Preservation experiments, and 48 or 72 hr in the pancreas Preservation experiments. HL-I solution was superior to both HL-II and UW solution for heart Preservation (1-week graft survival rates of 100% [7/7], 0% [0/5], and 50% [3/6], respectively). HL-I and HL-II were superior to UW for 24 hr Liver Preservation (1-week graft survival rates of 78% [11/14], 80% [8/10], and 29% [5/17], respectively). In contrast, HL-II was superior to both HL-I and UW solutions for pancreas Preservation following both 48-hr Preservation and 72-hr Preservation. Satisfactory graft function was achieved in 100% (7/7), 40% (6/15), and 44.4% (4/9) of pancreases transplanted after 48 hr using HL-II, HL-I, and UW solutions, respectively, and in 50% (4/8), 0% (0/8), and 0% (0/8) following 72-hr Preservation. Histidine- and lactobionate-containing solutions thus represent a further improvement in organ Preservation by simple cold storage.

  • A comparison of a new solution combining histidine and lactobionate with UW solution and eurocollins for rat Liver Preservation.
    Transplantation, 1991
    Co-Authors: Ryo Sumimoto, Naoshi Kamada, Neville V. Jamieson, Yasuhiko Fukuda, Kiyohiko Dohi
    Abstract:

    Forty-six rat Liver transplants were performed to investigate the effectiveness of a simplified lactobionate solution containing histidine as a buffer (histidine-lactobionate solution) and to compare it with University of Wisconsin solution. This new solution is isoosmotic (320 mOsm/L) and has a higher sodium content and a lower potassium content (Na: 90 mEq/L, K: 45 mEq/L) than standard UW solution. Buffering capacity is increased by adding histidine (90 mM/L) together with KH2PO4 (20 mM/L) and is greater than that of Eurocollins solution or UW solution. Adenosine, insulin, hydroxyethyl starch, and dexamethasone that are included in UW solution are not included in the new solution. The 1-week survival rate of rats transplanted with Livers preserved in this solutions at 4 degrees C was 85% (11/13) following 24-hr Preservation and 33% (2/6) after 30-hr Preservation. By contrast, UW solution gave only a 29% (5/17) survival rate after 24-hr Preservation and 0% (0/6) survival after 30-hr Preservation, demonstrating that this simplified UW solution with histidine is superior to UW solution in rat Liver Preservation. No rats (0/4) receiving Livers preserved for 24 hr in Eurocollins solution survived. These findings show that the inclusion of histidine as a buffer dramatically improves the effectiveness of lactobionate-based Preservation solutions and justify application in a large-animal model and subsequently in clinical Liver transplantation.