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Improved cardiac allograft function following triiodothyronine therapy to both donor and recipient.

Brain death is associated with neuroendocrine changes, in particular with a significant reduction of plasma-free triiodothyronine (T3) that results in impaired aerobic metabolism. Myocardial energy stores are reduced and tissue lactate increased. Cardiac function deteriorates. Similar metabolic changes are seen in patients undergoing open-heart surgery on cardiopulmonary bypass, including those undergoing heart transplantation. Therapy with T3 leads to a reversal of these metabolic changes, resulting in improved cardiac function. One hundred and sixteen consecutive potential donors have been so treated, as have 70 of the recipients. Immediate posttransplant cardiac function was good in all but 3, and these hearts recovered to normal within a maximum of 24 hr of mechanical support. In 2 small randomized trials in patients undergoing myocardial revascularization on cardiopulmonary bypass, postoperative T3 therapy was associated with a reduced need for inotropic support and diuretic therapy in the first study and improved cardiac output in the second study.

Adenosine Triphosphate

Bile acid profile as early indicator of allograft function during orthotopic liver transplantation.

Orthotopic liver transplantation was performed in 20 pigs. Serum total bile acids (STBA) were determined and their profile compared with standard early function parameters: total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactic acid. In phase I, the STBA level was 32.89 +/- 1.29 mumol/l. In phase II, STBA accumulated to 84.46 +/- 15.25 mumol/l (p less than 0.01), followed by hepatic clearance in phase III (63.61 +/- 9.71 mumol/1; NS). Between phase III and 6- and 12-hour samples, STBA decreased progressively, reaching values of 33.63 +/- 7.05 mumol/l at 24 h. AST was elevated in phases I, II, III, and at 6, 12 and 24 h (p less than 0.001), as was ALT (but with insignificant differences). Thus, STBA and their profile appear to be earlier and more specific indicators of early graft function than conventional parameters.

Alanine Transaminase

Do donor age and cold-ischemia time have a detrimental effect on early pancreas-allograft function?

To study the impact of donor age and cold-ischemia time (CIT) on early graft function, we retrospectively divided the donors of 51 pancreas transplants performed between 1979 and 1987 at Innsbruck University Hospital into four groups according to donor age (greater than 45 yr and less than 15 yr) and CIT (greater than 8 h and less than 3 h). All organs were perfused with Eurocollins solution and stored at 4 degrees C. Fasting blood glucose levels and total amount of pancreatic juice produced over the first 3 postoperative days were recorded to assess graft function. No statistically significant difference was found between groups 1 and 2 and between groups 3 and 4. From these data, it is concluded that with the preservation method used, CIT can without a doubt be extended to at least 12 h, and a maximum donor age similar to that for the kidney can be adopted. This might not only enlarge the donor pool but also facilitate distant organ procurement.

Age Factors

Serum bile acid monitoring as an early indicator of allograft function in canine orthotopic liver transplantation.

This study was undertaken to elucidate the correlation between early graft function and serum bile acids profile in canine orthotopic liver transplantation (OLT). The recipient dogs were categorized into four groups: group A (n = 5); bile output over 10 ml during initial 6 hours, group B (n = 4); bile output less than 1 ml during the same period, group C (n = 5); transplanted immediately after graft harvesting, and group D (n = 5); transplanted after 7-hour ice-cold preservation in lactated Ringer's solution. In all cases serum total bile acid (TBA) was markedly elevated during anhepatic phase, the value being 49.4 +/- 48.5 mumol/L. However, in group A, TBA decreased promptly after revascularization, the value at 4-hour being 14.7 +/- 12.7 mumol/L. In contrast, the corresponding TBA level in group B was 62.3 +/- 27.5 mumol/L 4 hours later (p < 0.01 vs group A). In group C, TBA also decreased immediately after reperfusion. Furthermore, in comparison between groups C and D, TBA level was significantly different 4 and 6 hours after reperfusion (p < 0.01). In the reduction rate of TBA (value at each time point after reperfusion the value immediately before reperfusion), the significant difference was observed after 2 hours between groups A and B (p < 0.05). In addition, significant difference was recognized at 30 minutes between groups C and D (p < 0.05). Although the changes of most bile acid fractions were proportional to the changes of TBA in all four groups, the detection of lithocolic acid at 6 hours was characteristic of both groups B and D. In conclusion, there was strong correlation between the TBA level and the graft function during early postoperative period. Therefore, TBA will be a specific and early indicator to differentiate the quality of the transplanted grafts in OLT.

Animals