Arterial blood flow predicts graft survival in liver transplant patients
Proper liver perfusion is essential for sufficient organ function after liver transplantation. The aim of this study was to determine the effects of portal and arterial blood flow on liver function and organ survival after liver transplantation. The arterial and portal venous blood flow was measured...
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| Veröffentlicht in: | Liver transplantation 2011-04, Vol.17 (4), p.436-445 |
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| creator | Pratschke, Sebastian Meimarakis, Georgios Mayr, Stephan Graeb, Christian Rentsch, Markus Zachoval, Reinhard Bruns, Christiane Josephine Kleespies, Axel Jauch, Karl‐Walter Loehe, Florian Angele, Martin Kurt |
| description | Proper liver perfusion is essential for sufficient organ function after liver transplantation. The aim of this study was to determine the effects of portal and arterial blood flow on liver function and organ survival after liver transplantation. The arterial and portal venous blood flow was measured intraoperatively by transit time flow measurement after reperfusion for 290 consecutive liver transplants. The graft survival, hepatic cell damage (alanine aminotransferase and aspartate aminotransferase), and liver function (prothrombin ratio and bilirubin) were determined. Grafts were stratified into groups according to arterial blood flow measurements [ |
| doi_str_mv | 10.1002/lt.22248 |
| format | Article |
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The aim of this study was to determine the effects of portal and arterial blood flow on liver function and organ survival after liver transplantation. The arterial and portal venous blood flow was measured intraoperatively by transit time flow measurement after reperfusion for 290 consecutive liver transplants. The graft survival, hepatic cell damage (alanine aminotransferase and aspartate aminotransferase), and liver function (prothrombin ratio and bilirubin) were determined. Grafts were stratified into groups according to arterial blood flow measurements [<100 mL/minute for arterial blood flow group I (ART I), 100‐240 mL/minute for ART II, and ≥240 mL/minute for ART III] and portal venous blood flow measurements (<1300 mL/minute for portal venous blood flow group I and ≥1300 mL/minute for portal venous blood flow group II). With multivariate analysis, the impact of blood flow on graft survival was determined, and potential confounders were considered. Decreased portal venous blood flow was associated with significantly less organ survival in univariate analysis but not in multivariate analysis. In contrast, the arterial blood flow was significantly correlated with organ survival after liver transplantation in univariate and multivariate analyses [hazard rate ratio = 2.5, confidence interval = 1.6‐4.1, P < 0.001, median survival = 56.6 (ART I), 82.7 (ART II), or 100.7 months (ART III)]. Moreover, low arterial blood flow resulted in impaired postoperative organ function and higher rates of primary nonfunction. Biliary complications were not affected by blood flow. Other risk factors for graft failure that were identified by multivariate analysis included retransplantation, histidine tryptophan ketoglutarate solution versus University of Wisconsin solution, and donor treatment with epinephrine. Impaired arterial blood flow after reperfusion represents a significant predictor of primary graft nonfunction and is associated with impaired graft survival. Whether the intraoperative measurement of hepatic arterial flow is predictive of graft survival should be evaluated in a prospective trial. Liver Transpl, 2011. © 2011 AASLD.</description><identifier>ISSN: 1527-6465</identifier><identifier>EISSN: 1527-6473</identifier><identifier>DOI: 10.1002/lt.22248</identifier><identifier>PMID: 21445927</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Adult ; Alanine Transaminase - blood ; Aspartate Aminotransferases - blood ; Bilirubin - blood ; Female ; Graft Survival ; Hepatic Artery - physiopathology ; Humans ; Liver Transplantation ; Male ; Middle Aged ; Multivariate Analysis ; Regional Blood Flow ; Retrospective Studies</subject><ispartof>Liver transplantation, 2011-04, Vol.17 (4), p.436-445</ispartof><rights>Copyright © 2011 American Association for the Study of Liver Diseases</rights><rights>Copyright © 2011 American Association for the Study of Liver Diseases.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3218-396151ae31a712fec8fe6e71166e56c52069f6d0175bf2551bad3d36cebc8e233</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flt.22248$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flt.22248$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21445927$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pratschke, Sebastian</creatorcontrib><creatorcontrib>Meimarakis, Georgios</creatorcontrib><creatorcontrib>Mayr, Stephan</creatorcontrib><creatorcontrib>Graeb, Christian</creatorcontrib><creatorcontrib>Rentsch, Markus</creatorcontrib><creatorcontrib>Zachoval, Reinhard</creatorcontrib><creatorcontrib>Bruns, Christiane Josephine</creatorcontrib><creatorcontrib>Kleespies, Axel</creatorcontrib><creatorcontrib>Jauch, Karl‐Walter</creatorcontrib><creatorcontrib>Loehe, Florian</creatorcontrib><creatorcontrib>Angele, Martin Kurt</creatorcontrib><title>Arterial blood flow predicts graft survival in liver transplant patients</title><title>Liver transplantation</title><addtitle>Liver Transpl</addtitle><description>Proper liver perfusion is essential for sufficient organ function after liver transplantation. The aim of this study was to determine the effects of portal and arterial blood flow on liver function and organ survival after liver transplantation. The arterial and portal venous blood flow was measured intraoperatively by transit time flow measurement after reperfusion for 290 consecutive liver transplants. The graft survival, hepatic cell damage (alanine aminotransferase and aspartate aminotransferase), and liver function (prothrombin ratio and bilirubin) were determined. Grafts were stratified into groups according to arterial blood flow measurements [<100 mL/minute for arterial blood flow group I (ART I), 100‐240 mL/minute for ART II, and ≥240 mL/minute for ART III] and portal venous blood flow measurements (<1300 mL/minute for portal venous blood flow group I and ≥1300 mL/minute for portal venous blood flow group II). With multivariate analysis, the impact of blood flow on graft survival was determined, and potential confounders were considered. Decreased portal venous blood flow was associated with significantly less organ survival in univariate analysis but not in multivariate analysis. In contrast, the arterial blood flow was significantly correlated with organ survival after liver transplantation in univariate and multivariate analyses [hazard rate ratio = 2.5, confidence interval = 1.6‐4.1, P < 0.001, median survival = 56.6 (ART I), 82.7 (ART II), or 100.7 months (ART III)]. Moreover, low arterial blood flow resulted in impaired postoperative organ function and higher rates of primary nonfunction. Biliary complications were not affected by blood flow. Other risk factors for graft failure that were identified by multivariate analysis included retransplantation, histidine tryptophan ketoglutarate solution versus University of Wisconsin solution, and donor treatment with epinephrine. Impaired arterial blood flow after reperfusion represents a significant predictor of primary graft nonfunction and is associated with impaired graft survival. Whether the intraoperative measurement of hepatic arterial flow is predictive of graft survival should be evaluated in a prospective trial. Liver Transpl, 2011. © 2011 AASLD.</description><subject>Adult</subject><subject>Alanine Transaminase - blood</subject><subject>Aspartate Aminotransferases - blood</subject><subject>Bilirubin - blood</subject><subject>Female</subject><subject>Graft Survival</subject><subject>Hepatic Artery - physiopathology</subject><subject>Humans</subject><subject>Liver Transplantation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Regional Blood Flow</subject><subject>Retrospective Studies</subject><issn>1527-6465</issn><issn>1527-6473</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kFFLwzAUhYMobk7BXyB586kzN2nS9nEMdcLAl_kc0vZWIllbk3Rj_966TZ_OhfNxOecQcg9sDozxJxfnnPM0vyBTkDxLVJqJy_9byQm5CeGLMQBZsGsy4ZCmsuDZlKwWPqK3xtHSdV1NG9ftae-xtlUM9NObJtIw-J3djYhtqbM79DR604bemTbS3kSLbQy35KoxLuDdWWfk4-V5s1wl6_fXt-VinVSCQ56IQoEEgwJMBrzBKm9QYQagFEpVSc5U0aiaQSbLhksJpalFLVSFZZUjF2JGHk9_e999Dxii3tpQoRvDYDcEnY-98oIV-Ug-nMmh3GKte2-3xh_0X_kRSE7A3jo8_PvA9O-o2kV9HFWvN0cVPzviaLs</recordid><startdate>201104</startdate><enddate>201104</enddate><creator>Pratschke, Sebastian</creator><creator>Meimarakis, Georgios</creator><creator>Mayr, Stephan</creator><creator>Graeb, Christian</creator><creator>Rentsch, Markus</creator><creator>Zachoval, Reinhard</creator><creator>Bruns, Christiane Josephine</creator><creator>Kleespies, Axel</creator><creator>Jauch, Karl‐Walter</creator><creator>Loehe, Florian</creator><creator>Angele, Martin Kurt</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201104</creationdate><title>Arterial blood flow predicts graft survival in liver transplant patients</title><author>Pratschke, Sebastian ; Meimarakis, Georgios ; Mayr, Stephan ; Graeb, Christian ; Rentsch, Markus ; Zachoval, Reinhard ; Bruns, Christiane Josephine ; Kleespies, Axel ; Jauch, Karl‐Walter ; Loehe, Florian ; Angele, Martin Kurt</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3218-396151ae31a712fec8fe6e71166e56c52069f6d0175bf2551bad3d36cebc8e233</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Alanine Transaminase - blood</topic><topic>Aspartate Aminotransferases - blood</topic><topic>Bilirubin - blood</topic><topic>Female</topic><topic>Graft Survival</topic><topic>Hepatic Artery - physiopathology</topic><topic>Humans</topic><topic>Liver Transplantation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Regional Blood Flow</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pratschke, Sebastian</creatorcontrib><creatorcontrib>Meimarakis, Georgios</creatorcontrib><creatorcontrib>Mayr, Stephan</creatorcontrib><creatorcontrib>Graeb, Christian</creatorcontrib><creatorcontrib>Rentsch, Markus</creatorcontrib><creatorcontrib>Zachoval, Reinhard</creatorcontrib><creatorcontrib>Bruns, Christiane Josephine</creatorcontrib><creatorcontrib>Kleespies, Axel</creatorcontrib><creatorcontrib>Jauch, Karl‐Walter</creatorcontrib><creatorcontrib>Loehe, Florian</creatorcontrib><creatorcontrib>Angele, Martin Kurt</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Liver transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pratschke, Sebastian</au><au>Meimarakis, Georgios</au><au>Mayr, Stephan</au><au>Graeb, Christian</au><au>Rentsch, Markus</au><au>Zachoval, Reinhard</au><au>Bruns, Christiane Josephine</au><au>Kleespies, Axel</au><au>Jauch, Karl‐Walter</au><au>Loehe, Florian</au><au>Angele, Martin Kurt</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Arterial blood flow predicts graft survival in liver transplant patients</atitle><jtitle>Liver transplantation</jtitle><addtitle>Liver Transpl</addtitle><date>2011-04</date><risdate>2011</risdate><volume>17</volume><issue>4</issue><spage>436</spage><epage>445</epage><pages>436-445</pages><issn>1527-6465</issn><eissn>1527-6473</eissn><abstract>Proper liver perfusion is essential for sufficient organ function after liver transplantation. The aim of this study was to determine the effects of portal and arterial blood flow on liver function and organ survival after liver transplantation. The arterial and portal venous blood flow was measured intraoperatively by transit time flow measurement after reperfusion for 290 consecutive liver transplants. The graft survival, hepatic cell damage (alanine aminotransferase and aspartate aminotransferase), and liver function (prothrombin ratio and bilirubin) were determined. Grafts were stratified into groups according to arterial blood flow measurements [<100 mL/minute for arterial blood flow group I (ART I), 100‐240 mL/minute for ART II, and ≥240 mL/minute for ART III] and portal venous blood flow measurements (<1300 mL/minute for portal venous blood flow group I and ≥1300 mL/minute for portal venous blood flow group II). With multivariate analysis, the impact of blood flow on graft survival was determined, and potential confounders were considered. Decreased portal venous blood flow was associated with significantly less organ survival in univariate analysis but not in multivariate analysis. In contrast, the arterial blood flow was significantly correlated with organ survival after liver transplantation in univariate and multivariate analyses [hazard rate ratio = 2.5, confidence interval = 1.6‐4.1, P < 0.001, median survival = 56.6 (ART I), 82.7 (ART II), or 100.7 months (ART III)]. Moreover, low arterial blood flow resulted in impaired postoperative organ function and higher rates of primary nonfunction. Biliary complications were not affected by blood flow. Other risk factors for graft failure that were identified by multivariate analysis included retransplantation, histidine tryptophan ketoglutarate solution versus University of Wisconsin solution, and donor treatment with epinephrine. Impaired arterial blood flow after reperfusion represents a significant predictor of primary graft nonfunction and is associated with impaired graft survival. Whether the intraoperative measurement of hepatic arterial flow is predictive of graft survival should be evaluated in a prospective trial. Liver Transpl, 2011. © 2011 AASLD.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>21445927</pmid><doi>10.1002/lt.22248</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Alanine Transaminase - blood Aspartate Aminotransferases - blood Bilirubin - blood Female Graft Survival Hepatic Artery - physiopathology Humans Liver Transplantation Male Middle Aged Multivariate Analysis Regional Blood Flow Retrospective Studies |
| title | Arterial blood flow predicts graft survival in liver transplant patients |
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