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F Mühlbacher

Publications and source records attributed to F Mühlbacher.

At least 55 records · Page 3Linked to original sources
PubMed1997

The long-acting dopamine agonist bromocriptine mesylate as additive immunosuppressive drug after kidney transplantation.

BACKGROUND: Acute rejection is an important risk factor for kidney graft loss. As evidence suggests that prolactin has important immunostimulatory properties, we conducted a randomized, prospective open trial in which bromocriptine, a drug suppressing prolactin secretion, was administered as an additive immunosuppressive drug after first cadaver kidney transplantation. METHODS: In the treatment group bromocriptine was given intramuscularly to 22 patients after their first kidney transplantation along with conventional immunosuppression (cyclosporin A, glucocorticoids). Twenty-three patients receiving only conventional immunosuppression served as control subjects. The incidence of acute graft rejections, graft losses, and infections was evaluated. RESULTS: Serum prolactin concentrations were slightly elevated above normal values before transplantation (32 +/- 5.3 ng/ml) and decreased to values between 13 and 16 ng/ml in the control group and were totally suppressed in the bromocriptine group. After 6 months of follow-up overall patient and allograft survival was 97.7% and 91% respectively. Acute rejection episodes occurred in 31 patients (77.5%): 15 in the bromocriptine group vs 20 in the control group (n.s.). In each group eight patients experienced a cytomegalovirus infection. The incidence of severe bacterial infections (i.e. pneumonia and sepsis) was five and six respectively. The necessity of haemodialysis after transplantation was 3.1% in the patients on bromocriptine and 23% in those without. CONCLUSIONS: Suppression of circulating prolactin concentration by bromocriptine did not improve the clinical outcome of patients after kidney transplantation receiving cyclosporin and prednisolone.

Acute Disease↗
PubMed1996

[Early postoperative infections after liver transplantation--pathogen spectrum and risk factors].

Infections occurring during the early postoperative phase after liver transplantation result in a significant rise in morbidity and mortality. The records of 279 orthoptic transplantations performed in 248 patients were analyzed retrospectively. 55.6% of all patients suffered from one or more episodes of bacterial and/or fungal infection during their postoperative hospitalisation. The median onset of bacterial/fungal infection was on day 7 after transplantation. Enterococci (42 episodes), Pseudomonas aeruginosa (38 episodes), staphylococci (37 episodes), Escherichia coli (17 episodes) and Candida albicans (11 episodes) were the most frequently detected organisms. 74 (29.8%) patients developed viral infections. 20 patients (8.1%) showed infection with cytomegalovirus (CMV), 32 patients (12.9%) with herpes simplex virus (HSV) and 6 patients (2.4%) with varicella zoster virus (VZV). 14 patients (5.6%) developed infection with both CMV and VZV. Triple infection with CMV, HSV and VZV occurred in one patient. Statistical analysis of potential risk factors showed a significant influence of blood volume replacement (p < 0.001) and occurrence of at least one rejection period (p < 0.02) for major bacterial/fungal infection and immunosuppression (p < 0.001), cold ischemic time (p < 0.04), occurrence of at least one rejection period (p < 0.005) and blood volume replacement (p < 0.04) for viral infection.

Adolescent↗
PubMed1996

Experience in renal autotransplantation: analysis of a clinical series.

OBJECTIVE: To determine the benefit of renal autotransplantation in selected patients with either renovascular lesions, renal or urothelial carcinomas or other disorders of the urinary collecting system. PATIENTS AND METHODS: Between 1977 and 1994, 12 patients underwent renal autotransplantation, six involving renovascular hypertension, two involving tumours of the renal parenchyma, two with urothelial tumours and two with long ureteric stenoses. Pre-operative renal function was normal in six patients and impaired in five. One patient was on haemodialysis. Five patients had a solitary kidney and four patients had functionally solitary kidneys. The follow-up period ranged from 1 to 93 months (mean 34.9). RESULTS: Post-operatively, six patients had normal kidney function (serum creatinine < or = 12 mg/L), five patients had impaired renal function (creatinine content < or = 26 mg/L) and one patient was on haemodialysis due to arterial graft thrombosis. Serum creatinine levels improved in four patients and were stable in another four. Renal function deteriorated in three patients and one patient required a graft-nephrectomy. Immediate post-operative complications included arterial thrombosis in one patient, perirenal haematoma in two, pulmonary oedema in one and severe intra-operative bradycardia requiring a transient cardiac pacemaker in one. CONCLUSION: Renal autotransplantation represents an effective alternative treatment with good long-term results for selected patients with long ureteric lesions and renovascular disorders. It is also an effective method for patients with urological malignancies, especially those with solitary kidneys where the maintenance of renal function is of major concern.

Adult↗
PubMed1996

Effect of desmopressin substitution during organ procurement on early renal allograft function.

BACKGROUND: As diabetes insipidus in brain-dead organ donors leads to hypovolaemia, hyponatraemia, and hypotension, desmopressin is recommended for treatment of diabetes insipidus. As its effect on early renal allograft function remains unclear, we conducted a study to evaluate the effect of desmopressin on renal-graft survival. METHODS: We report the results of a prospective study in 41 brain-dead organ donors (mean age 45 +/- 12 years) with diabetes insipidus, who were treated either with adequate fluid substitution and bolus application of desmopressin (desmopressin group; n = 22) or with volume substitution along (control group; n = 19). Donors as well as recipients of both groups were well matched with respect to age, sex, dopamine dosage, serum electrolytes, cold ischaemic time, HLA match, number of prior transplantations, and current cytotoxic antibodies. Early renal allograft function was evaluated in 71 recipients (mean age 48 +/- 4 years within 3 days after transplantation. RESULTS: Overall, primary non-function was observed in 26 (36.6%) of 71 recipients. The rate of primary non-function was significantly higher in the desmopressin group compared to the control group (desmopressin group 48.6%; control group 23.5%; P = 0.28). CONCLUSION: The use of desmopressin during organ procurement is associated with a higher rate of primary non-function of renal allografts.

Adolescent↗
PubMed1996

Psychiatric prognostic factors in patients with alcohol-related end-stage liver disease before liver transplantation.

UNLABELLED: Discussion of selection criteria for liver transplantation in alcoholics has been controversial. The concern that there might be a return to alcohol misuse after transplantation which would cause non-compliance with post-transplantation management is not supported by recent reports. Six months of abstinence have been required generally as exclusion criterion, no other psychiatric prognostic factors have been evaluated up to now. METHODS: In 39 consecutive patients with alcohol-related end-stage liver disease who were referred to the Surgical University Clinic of Vienna for transplantation the psychiatric prognostic factors abstinence for at least six months, motivation (defined as combination of insight into the necessity of abstinence and readiness for alcohol dependence treatment) and compliance (which was stated to be positive if the psychiatric counselling dates were kept by the patients) were evaluated regarding survival for at least one year. RESULTS: Abstinence of at least six months failed to prove to be a positive influence on survival. In contrast, motivation and compliance proved to be good psychiatric prognosis parameters.

Adult↗
PubMed1995

Arginase release following liver reperfusion. Evidence of hemodynamic action of arginase infusions.

Immediately after hepatic reperfusion in human orthotopic liver transplantation, high amounts of arginase are released from the graft, thereby influencing nitric oxide metabolism. This metabolic alteration may be one component of the ischemia-reperfusion syndrome in OLT with its hemodynamic disturbances (e.g., systemic hypotension, pulmonary hypertension). The aim of this study was to compare hemodynamic and metabolic changes following OLT in the pigs with those obtained under arginase infusions in catheterized, anesthetized pigs. Following liver revascularization in the pigs, plasma arginase concentrations increased from 48 +/- 19 IU/L to 2613 +/- 944 IU/L, resulting in a drop in plasma levels of L-arginine (-87%) and in a drop in nitrite (-82%) and nitrate (-53%) concentrations. Of the measured organ-specific hemodynamic alterations, the mean pulmonary arterial pressure increased from 17 +/- 2 mmHg to 30 +/- 5 mmHg, whereas the flow/pressure index of the portal vein decreased about 60%. A primed continuous infusion of arginase (25,000 IU) increased plasma arginase levels to a maximum of 3,690 +/- 962 IU and evoked a decrease of L-arginine, but did not alter plasma nitrite or nitrate levels. The administration of arginase in healthy pigs did not influence cardiac output, mean arterial pressure, heart rate, or total peripheral resistance, but led to an increase of mean pulmonary arterial pressure from 19 +/- 3 to 48 +/- 5 mmHg and to a reduction of arterial hepatic blood flow from 229 +/- 65 ml/min to 154 +/- 41 ml/min. From this we conclude that high levels of liver arginase cause hemodynamic alterations in the lung and the liver. We hypothesize that the pulmonary hypertension and the reduced hepatic blood flow found during the immediate reperfusion period after OLT are possibly related to the increased arginase release due to the hepatic damage of the graft.

Animals↗
PubMed1995

Biliary sludge after liver transplantation: 2. Treatment with interventional techniques versus surgery and/or oral chemolysis.

OBJECTIVE: Interventional treatment of biliary sludge in liver transplant recipients includes transhepatic biliary drainage and saline irrigation, catheter chemolysis and/or basket extraction, and endoscopic intervention. The purpose of this study was to compare these interventional procedures with oral chemolysis and with surgical treatment of biliary sludge in order to evaluate the effectiveness of interventional procedures as an alternative to surgery in the treatment of this complication. MATERIALS AND METHODS: We retrospectively evaluated the outcome of several forms of treatment for biliary sludge occurring after liver transplantation in 49 cases. Treatments included oral chemolysis with chenodeoxycholic acid (n = 35), percutaneous transhepatic biliary drainage (n = 13) followed by irrigation with heparinized saline solution (n = 4), intraluminal chemolysis with glycero-octanoate-carnosine and bile salts-EDTA (n = 3) and/or basket extraction (n = 5), and endoscopic intervention (n = 2) or surgery (n = 26). Oral chemolysis was attempted in all cases of biliary sludge if no other complications were present. If this conservative treatment failed and the sludge was limited to the main bile ducts, interventional procedures were attempted. Surgical removal of the sludge (n = 15) or retransplantation (n = 5) without any attempt at prior nonsurgical treatment was performed if concomitant complications were present (n = 14) or if the extent of the sludge was considered too time-consuming for an interventional attempt (n = 6). The six patients in whom nonsurgical treatment failed underwent surgery. Treatment was considered successful if cholangiograms obtained after therapy showed no more evidence of sludge. Treatment was considered a failure if biliary sludge was shown after therapy by means of cholangiography, surgery, or autopsy. RESULTS: Complete disappearance of biliary sludge as a result of oral chemolysis was achieved in 14 (40%) of 35 cases. Interventional procedures were performed in 15 of the patients in whom oral treatment failed. After percutaneous transhepatic biliary drainage, the sludge was successfully removed by chemolysis with glycero-octanoate-carnosine in three cases, by basket extraction in one case, and by a combination of chemolysis and basket extraction in three cases. In two other cases, underlying recurrent tumor was treated palliatively with percutaneous transhepatic biliary drainage or endoscopic stenting. Irrigation with heparinized saline solution failed in four cases, and percutaneous or endoscopic basket extraction failed in one case each. Surgical treatment was successful in 18 (86%) of 21 cases, and retransplantation was successfully done in five patients. In all, interventional techniques were used in 43% of the patients with biliary sludge who could not be treated successfully with oral chemolysis, and the overall success rate was 60%. CONCLUSION: Interventional techniques are effective therapeutic alternatives for treating biliary sludge occurring after liver transplantation and should be considered before surgical procedures. An indication for interventional procedures in biliary sludge is lack of success of oral chemolysis and an absence of other complications that require surgery or retransplantation.

Adolescent↗
PubMed1995

Biliary sludge after liver transplantation: 1. Imaging findings and efficacy of various imaging procedures.

OBJECTIVE: Biliary sludge (inspissated, thickened bile or collective collagen tissue from destroyed [or necrotic] bile duct walls) can be found a few days to several years after liver transplantation, mainly in the common and main hepatic bile ducts. The purpose of this study was to review the imaging findings of biliary sludge occurring after liver transplantation and to determine the relative merits of various imaging procedures (cholangiography, CT, and sonography) for establishing the diagnosis. MATERIALS AND METHODS: Cholangiograms, sonograms, and CT scans obtained in 352 patients with 400 liver transplants were reviewed retrospectively for evidence of biliary sludge. In all patients, T-tube cholangiograms were routinely obtained 7 and 30 days and 3 months after transplantation. Thereafter, in the absence of findings, the T-tube was removed. In all patients, sonograms were obtained immediately, 2 and 7 days after transplantation. Additional cholangiograms were obtained when biliary complications were suspected (T-tube cholangiograms in 215 patients, percutaneous transhepatic cholangiograms in 79 patients, and endoscopic retrograde cholangiograms in five patients after T-tube removal). Additional sonograms were obtained in 289 patients and CT scans in 238 patients when complications were suspected. The findings of these various imaging studies were analyzed and compared with each other, with the clinical course of the patient, and with surgical and histologic findings to determine the relative merits of each imaging method for the diagnosis of biliary sludge. Criteria for the diagnosis of biliary sludge were filling defects or pluglike obstruction seen on cholangiograms or material filling the bile ducts seen on sonograms or CT scans. The radiologic diagnosis of biliary sludge was certified by gross specimens obtained at surgery (n = 21) or autopsy (n = 2) or by complete disappearance of the radiologic findings with specific oral or interventional treatment (n = 28). RESULTS: Biliary sludge was diagnosed on the basis of radiologic findings in 51 (13%) of 400 transplanted livers. Cholangiograms (T-tube in 34, percutaneous transhepatic cholangiography in seven, a combination of T-tube and percutaneous transhepatic cholangiography in eight, and a combination of endoscopic retrograde and percutaneous transhepatic cholangiography in two cases) showed biliary sludge in all 51 cases. Cholangiographic findings included filling defects in 34 (67%) and obstruction of the bile duct with pluglike appearance in 17 (33%) of the 51 cases. Dilatation of bile ducts was present in 32 (63%) of the 51 cases. The presence of biliary sludge was certified in 50 of these cases, with one case turning out to be a sutural granuloma at autopsy. On sonograms, biliary sludge was shown as echogenic material in the main bile ducts in only 16 (31%) of the 51 cases, with dilatation of bile ducts in 12 of them. In 10 others (20%), sonograms showed dilatation of the bile ducts but did not show the sludge itself. CT scans did not show the sludge in any of the 12 cases in which they were obtained. CONCLUSION: Our results show that cholangiography is the only accurate imaging method for diagnosing biliary sludge after liver transplantation. Sonography is limited and CT is of no value for this purpose. In the absence of a T-tube, endoscopic retrograde or percutaneous transhepatic cholangiography should be used. Otherwise, T-tube cholangiography is the method of choice. Filling defects and obstruction of the bile ducts with pluglike material are characteristic findings of biliary sludge seen on cholangiograms.

Adolescent↗
PubMed1995

Tumour necrosis factor-alpha and interleukin-6: early indicators of bacterial infection after human orthotopic liver transplantation.

OBJECTIVE: To see if it was possible to predict the development of infection after liver transplantation from concentrations of endotoxin, tumour necrosis factor-alpha (TNF-alpha), or interleukin-6 (IL-6) in plasma. DESIGN: Prospective open study. SETTING: University hospital, Austria. SUBJECTS: 46 Consecutive patients who underwent liver transplantation for end stage liver disease, 1989-90. INTERVENTIONS: Samples of 4 ml blood were taken in endotoxin free tubes, and of 10 ml into heparinised tubes at the beginning of the operation, during hepatectomy, at the beginning and end of the anhepatic phase, 10 minutes after reperfusion, and at the end of the operation. MAIN OUTCOME MEASURES: Correlation between development of infections postoperatively and operative release of endotoxin, TNF-alpha, and IL-6. RESULTS: There was no correlation between development of postoperative infections and operative concentrations of endotoxin, and of TNF-alpha and IL-6 up to the end of the anhepatic phase. There was, however, a sixfold increase in TNF-alpha and IL-6 concentrations between the end of the anhepatic phase and the end of the operation in patients who subsequently developed infections (p = 0.01). CONCLUSION: The increase in the concentrations of these two cytokines in the blood after reperfusion of the transplanted liver seems to predict the development of subsequent bacterial infection.

Adult↗
PubMed1994

Efficacy of liver transplantation for alcoholic cirrhosis with respect to recidivism and compliance.

Many transplant centers are reluctant to accept alcoholic patients for OLT because of their supposed potential for alcoholic recidivism and poor compliance with the required immunosuppressive regimen, both of which result in graft failure. Only inconclusive data related to these arguments are available. From May 1982 to January 1993, 58 patients received OLT at our institution for end-stage cirrhosis, where alcohol was the only toxic component. The indication for OLT in these patients was considered with particular attention to recidivism and compliance. Overall survival in this group was 71% and 63% at 1 and 5 years, respectively, with an average survival time of 78 months. Actuarial survival of patients transplanted since January 1989 (n = 37) was 86% and 83% at 1 and 2 years (average survival 42 months). Nonfatal clinical endpoints were analyzed in those patients surviving at least 3 months (n = 44). Return to alcohol abuse has been documented in 14 persons at routine short-term outpatient checkups. The estimated risk for alcoholic recidivism amounts to 31%, with a median follow-up of 33 months. Compliance with immunosuppressive regimen was expressed as a dependent value of acute rejection episodes (0.3 per patient, median follow-up 33 months), chronic rejection (occurred in none of the patients), and measurements of CsA HPLC blood trough level (92.2% within the target range). The preversus postoperative improvement of employment, marital, and social status after OLT showed a statistically significant difference. Unwillingness to offer OLT to individuals with alcoholic liver disease because of failure to demonstrate 100% long-term abstinence appears difficult to defend in the face of good results in survival, compliance, and social rehabilitation.

Adult↗
PubMed1994

Transhepatic metabolism of TNF-alpha, IL-6, and endotoxin in the early hepatic reperfusion period after human liver transplantation.

Several studies have shown that the postoperative course of cytokines such as TNF-alpha or IL-6 is predictive of rejection and infection after human orthotopic liver transplantation (OLT). The aim of this prospective clinical trial was to evaluate the impact of transhepatic metabolism of endotoxin (ET), tumor necrosis-factor-alpha (TNF-alpha), and interleukin-6 (IL-6) after hepatic ischemia/reperfusion on the postoperative graft function. In 13 consecutive elective adult OLT patients with primary grafts, we determined concentrations of ET, TNF-alpha, and IL-6 in the radial artery, portal vein, and right hepatic vein at 1, 4, 7, 10, and 13 min after reperfusion. Of the 13 patients, four had ET levels below the detection limit (< 10 ng/L), and one patient had extremely high ET concentrations (151 ng/L in the hepatic vein). In the remaining patients the mean ET levels were 26 +/- 14, 26 +/- 15, and 24 +/- 14 ng/L in the portal vein, hepatic vein, and in the radial artery, respectively. These values indicate that in patients with a moderately elevated ET level, no transhepatic concentration differences of ET exist. However, in the patient with severe endotoxemia, the liver was apparently an ET-producing organ (HV-P: 29 +/- 13 ng/L). TNF-alpha levels were not measurable in four patients, and varied between 15 and 72 pg/ml (portal vein) in the remaining patients. The transhepatic concentration differences (HV-P and HV-A, respectively) of patients with PNF or dysfunction were higher than in those with "good" or "excellent" graft function (HV-P: 160 +/- 122 pg/ml vs. 7.3 +/- 9.7 pg/ml; P < 0.01 and HV-A: 137 +/- 101 pg/ml vs. 3.9 +/- 12 pg/ml; P < 0.01, respectively). Arterial IL-6 levels were below 88 pg/ml (mean value: 31 +/- 20 pg/ml) at the beginning of the operation, and increased considerably in three patients during the anhepatic phase and after reperfusion. No clinical correlation was found with the transhepatic concentration differences of IL-6. We conclude that in OLT patients without infection no transhepatic ET exchange was documented. However, a stimulated hepatic TNF-alpha release seems to be predictive of the beginning of liver dysfunction.

Adolescent↗
PubMed1994

L-Arginine deficiency after liver transplantation as an effect of arginase efflux from the graft. Influence on nitric oxide metabolism.

L-Arginine plays an important role in protecting animals against ammonia intoxication, enhances immune function, stimulates wound healing, and is the precursor for the endothelium-derived relaxing factor, recently recognized as nitric oxide (NO). In this study, we investigated the influence of hepatic reperfusion on amino acid metabolism after human OLT. After 10 sec of reperfusion, the arterial plasma levels of L-arginine dropped from 105 +/- 12 mumol/L to 3.8 +/- 0.6 mumol/L (P < 0.001), whereas plasma ornithine increased from 40 +/- 5.5 mumol/L to 129 +/- 15 mumol/L (P < 0.001). The reduced L-arginine levels remained subnormal for several hours after OLT. This drop in plasma L-arginine was due to an arginase release from the implanted graft. Immediately after reperfusion, the plasma concentrations of arginase increased from pretransplantation values of 18 +/- 13 IU/L to 2384 +/- 1456 IU/L (P < 0.01). Measurement of plasma nitrite (NO2-) and nitrate (NO3-), which are the stable end products of NO, revealed that NO2- decreased about 50% after reperfusion (from 1.64 +/- 0.32 mumol/L to 0.80 +/- 0.17 mumol/L; P < 0.001), whereas NO3- levels remained unchanged (76 +/- 23 mumol/L vs. 63 +/- 8 mumol/L). We conclude that hepatic reperfusion causes L-arginine deficiency by liberating high amounts of arginase from the implanted graft. This L-arginine depletion may influence the NO synthesis in patients after OLT.

Adult↗
PubMed1994

Transplantation for alcoholic cirrhosis: how does recurrence of disease harm the graft?

Many transplant centres are reluctant to accept alcoholic patients because of their supposed potential for alcoholic recidivism, resulting in graft failure and recurrence of alcoholic liver cirrhosis. From May 1982 to January 1993 80 patients received orthotopic liver transplantation (OLT) at our institution either for alcoholic cirrhosis exclusively (n = 58) or for a hepatoma in an alcoholic cirrhosis (n = 22). The outcome of these patients was analysed with particular attention to recurrence of liver disease. Overall survival in this group was 67% and 49% at 1 and 5 years, respectively, with a median follow-up of 45 months. Actuarial survival of patients transplanted since January 1989 (n = 46) and 84% and 82% at 1 and 2 years (median follow-up 31 months). Non-fatal clinical endpoints were analysed in those patients surviving for at least 3 months (n = 61). Return to alcohol abuse was documented in 16 patients at routine short-term out patient check-ups. All patients except one admitted to taking alcohol and showed changes in their laboratory test results. A specific pattern of liver function test values related to alcohol abuse was not detected and at the end of a relapse the liver function values usually returned to pre-event values. Only in one case was toxic injury of the liver related to alcoholic recidivism diagnosed on percutaneous liver needle biopsy or post-mortem examination. Compliance with the required immunosuppressive regimen and social rehabilitation after OLT were excellent. Unwillingness to offer OLT to individuals with alcoholic liver disease because of failure to demonstrate 100% long-term abstinence appears difficult to defend in the face of results showing good survival, compliance and social rehabilitation. The hypothesis of a higher sensitivity of the transplanted liver to a drinking episode and the redevelopment of alcoholic diesease in the new liver was not confirmed in our study population.

Carcinoma, Hepatocellular↗
PubMed1994

Influence of donor criteria on postoperative graft function after orthotopic liver transplantation.

Evaluation of graft quality remains a major problem in liver transplantation. The aim of this retrospective analysis was to examine the impact of donor criteria on postoperative graft function. Between June 1986 and September 1993 324 liver transplantations were performed at our institution. Criteria for exclusion from analysis were postoperative thrombosis of graft vessels, retransplantation, death prior to the 5th postoperative day or missing donor criteria. For the eligible 255 transplantations the impact of the following donor criteria were examined: age (range 1-62 years, median 28 years), size/body weigt index, duration of intensive care, cause of death, circulatory condition, need for vasopressive support and liver function tests (bilirubin, GOT, GPT, GGT, LDH, ALP, prothrombin time (PT), creatinine, sodium). The following intraoperative factors were also assessed: type of protective solution, cold ischaemic time (CIT), anhepatic period and blood transfusions. Graft function during the first 5 postoperative days was categorized into four groups: (1) good function (GOT max < 1000 U/l, spontaneous PT > 50%, bile production > 100 ml/day); (2) fair function (GOT 1000-2500 U/l, clotting factor support < 2 days, bile < 100 ml/day); (3) poor function (GOT > 2500 U/l, clotting factor support > 2 days, bile < 20 ml/day); (4) primary non-function (retransplantation required within 7 days). A univariate analysis revealed duration of intensive care (P = 0.001), circulatory condition (P = 0.005), anhepatic period (P = 0.0004), blood transfusions (P = 0.03) and CIT (P = 0.039) as significant risk factors for postoperative graft function. Entering these factors in a multivariate regression model we identified creatinine (P = 0.007), duration of intensive care (P = 0.009) and the size/body weight index (P = 0.03) as donor-related factors of high significance. Analysis of the intraoperative data revealed the anhepatic period as the factor of highest significance (P = 0.0004) together with CIT (P = 0.02) and intraoperative blood transfusions (P = 0.008). A doubling of the number of days of intensive care resulted in a threefold increased risk of postoperative graft failure. Prolonged intensive care is a variable representing multiple risk factors. Accepting donors with a longer history of hypotension or who show signs such as elevated creatinine should be carefully considered. In patients with expected surgical difficulties resulting in an extended anhepatic period and a higher blood loss, transplantation of organs retrieved from donors with a long duration of intensive care and a long CIT should be avoided.

Adolescent↗