Biomedical subjects

D Riaño Carrera

Publications and source records attributed to D Riaño Carrera.

11 recordsLinked to original sources

PubMed1991

Evaluation of surgical and anesthetic strategy as a key factor in the postoperative results of liver transplant.

Since the inauguration of our liver transplant program two years ago, retrospectively we can distinguish two different periods as regards postoperative results. The patients studied were distributed in two groups by chronological order and date of introduction of an improved surgical and anesthetic strategy: retrohepatic dissection during the veno-venous bypass phase and meticulous hemostasis in the anhepatic phase: Group A: 11 transplants in 10 patients and Group B: 22 transplants in 21 patients. Preoperatively, both groups were homogeneous with respect to the clinical situation. During the operation, significantly larger transfusion volumes were given in group A (25.4 +/- 10.5 ml/kg/hr) than in group B (10.0 +/- 5.7 ml/kg/hr) (p less than 0.01). The anhepatic phase lasted 1'50" +/- 20" in group B (p less than 0.05). The postoperative outcome of group B was better than that of A as regards hemodynamic and respiratory parameters, functional impairment of the graft and mortality (p less than 0.05). We conclude that the realization of retrohepatic dissection and careful hemostasis during the anhepatic phase, which prolongs the duration of venovenous by-pass but does not increase intraoperative morbidity, reduces the need for blood transfusion, and yields better postoperative results.

Adult↗

PubMed1990

[Liver transplantation and portal thrombosis].

One hundred and thirty-eight transplants were performed between April 1986 and June 1990 in 116 patients of whom 9 (7.75%) were affected by liver cirrhosis complicated by portal vein thrombosis. Occlusion of the vascular lumen was total in 3 cases, semitotal in 1 case and the percentage of obstruction ranged between 25% and 75% in the remaining patients. Venous dissection and thrombectomy were performed in 6 cases and simple thrombectomy in 3 cases in order to obtain a satisfactory blood flow. Anastomosis was effected using the spleno-mesenteric confluence in 2 cases and the portal vein itself in other patients. Recurrent thrombosis occurred in the first 4 patients in the series, but it was only fatal in 2 cases. The paper analyses the data obtained from the study and in conclusion confirms the use of transplant in cirrhotic patients with portal vein thrombosis.

Adult↗

PubMed1990

[Orthotopic liver transplantation: results at the "12 de Octubre" Hospital].

The authors report their experience on 132 liver transplants performed on 111 patients. Eighteen have a re-transplantation and in 3 of them a second retransplantation (total re-transplanted patients 21 = 15.9%). Hepatic cirrhosis was the most common indication (57.65%) for transplantation (34.37% of alcoholic etiology). The authors report briefly their operative techniques and the results of their experience. The per-operative mortality (30 days) was 16.21% (18/111). The most important complications were: 9 hepatic arterial thromboses (6.8%), 4 arterial strictures (3.03%), 1 portal stricture (0.75%), 4 portal vein thromboses (3.03%), 5 biliary fistulae (3.78%) (3 following biliary duct-to-duct anastomosis and 2 following hepatic-jejunoanastomosis) and 2 strictures of the choledocus (1.51%). The actuarial survival rate (48 months) is 80%.

Adolescent↗

PubMed1989

[Reduction of transfusion needs by the early introduction of venovenous bypass in liver transplant].

A study was made of 44 patients who underwent liver transplant, distributed into three groups: Group A: patients who had ample liver dissection before entering bypass. Group B: patients who entered bypass after dissection of the hepatic hilum and prior to any other dissection; bypass time was prolonged for meticulous hemostasia. Group C: patients with perfectly defined hemodynamic problems, not secondary to bleeding, during the anhepatic phase. Preoperatively the three groups were homogeneous as regards clinical situation. During the operation a significantly larger transfusion volume (p less than 0.01) was administered in group C during phase II (70.1 +/- 27.2 ml/kg/h), phase III (32.6 +/- 9.6 ml/kg/h) and throughout surgery (32.7 +/- 10.3 ml/kg/h) than in the other two groups. Group B received a smaller transfusion volume during phase II (14.6 +/- 8.1 ml/kg/h), phase III (12.7 +/- 5.5 ml/kg/h) and throughout surgery (11.6 +/- 4.9 ml/kg/h) than the other two groups (p less than 0.01). The transfusion needs of group A were 28.4 +/- 15.6 ml/kg/h in phase II, 26.8 +/- 17.1 ml/kg/h in phase III and 21.2 +/- 11.2 ml/kg/h throughout surgery. The duration of the anhepatic phase was significantly shorter (p less than 0.01) in group A (1 h 10' +/- 10) than in (1 h 50' +/- 10) and C (1 h 40' +/- 45'). In the postoperative period a higher mortality was associated with group C (37.5%) and a lower mortality with group B (3.33%), the mortality of group A being 16.6%. The differences were statistically significant with p less than 0.01.

Adult↗

PubMed1988