Background/aims: The liver is regarded the most important source of glucose production and it is common practice to administer glucose during human liver transplantations to avoid hypoglycaemia. The purpose of this study was to evaluate the importance of extra-hepatic contribution (kidney, gut and muscle) to the glucose homeostasis in the anhepatic pig and in man during the anhepatic phase of human liver transplantations.
Methods: Blood glucose and lactate were monitored in the anhepatic phase in 46 patients undergoing liver transplantation. Arterial-venous differences of lactate, glucose, glycerol, alanine and free fatty acids were measured over kidney, gut and hind leg in 18 pigs made anhepatic.
Results: Blood glucose did not change significantly and blood lactate increased only marginally during the anhepatic phase of human orthotopic liver transplantation. In the anhepatic pig, however, blood glucose decreased with a halflife of about 26 min and blood lactate increased. Kidney gluconeogenesis was 0.116+/-0.016 mmol min(-1). Fifty percent of kidney glucose output could be accounted for by lactate- and glycerol uptake.
Conclusions: The results show that in humans extra hepatic gluconeogenesis is sufficient to maintain normal blood glucose in the anhepatic phase of orthotopic liver transplantation, while in the pig this was not the case.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/s0168-8278(01)00241-0 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Transesophageal echocardiography monitoring for liver transplantation: where are we now?
Minerva Anestesiol
January 2025
Transplant Anesthesia and Critical Care, Pisa NHS and University Hospitals, Pisa, Italy -
Intraoperative hemodynamic monitoring is crucial for managing patients with end-stage liver disease (ESLD) undergoing orthotopic liver transplantation (OLT) due to their complex cardiovascular and pulmonary abnormalities. Traditionally, pulmonary artery catheterization (PAC) has been the standard for hemodynamic monitoring during OLT. However, the use of transesophageal echocardiography (TEE) has increased due to its real-time visualization of cardiac and vascular structures, which aids in managing hemodynamic instability during the three surgical phases of OLT: pre-anhepatic, anhepatic, and neo-hepatic.
View Article and Find Full Text PDFDonation After Circulatory Death Liver Transplantation: Impact of Normothermic Machine Perfusion on Key Variables.
Anesth Analg
September 2024
From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona.
Background: During orthotopic liver transplantation, allograft reperfusion is a dynamic point in the operation and often requires vasoactive medications and blood transfusions. Normothermic machine perfusion (NMP) of liver allografts has emerged to increase the number of transplantable organs and may have utility during donation after circulatory death (DCD) liver transplantation in reducing transfusion burden and vasoactive medication requirements.
Methods: This is a single-center retrospective study involving 226 DCD liver transplant recipients who received an allograft transported with NMP (DCD-NMP group) or with static cold storage (DCD-SCS group).
Comparison of target concentration of propofol during three phases of live donor liver transplant surgery using a target-controlled infusion of propofol total intravenous anaesthesia - A prospective, observational pilot study.
Indian J Anaesth
November 2024
Department of Anaesthesia, Institute of Liver and Biliary Sciences, Delhi, India.
Article Synopsis
- This study explores how the pharmacokinetics of propofol—specifically its required concentrations—varies in different phases (dissection, anhepatic, and neohepatic) during liver transplantation.
- It involved 20 patients with chronic liver disease, and used a target-controlled infusion method to adjust propofol levels based on the bispectral index (BIS), which measures consciousness levels.
- Results showed that the mean target concentration of propofol was highest during the dissection phase, significantly decreasing during the anhepatic and neohepatic phases, indicating a need for lower propofol dosages in those latter stages.
Simplified ischemia-free liver transplantation by providing alternating flow of the portal vein and hepatic artery: Applicability, efficiency, and safety.
Liver Transpl
December 2024
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Conventional ischemia-free liver transplantation (CIFLT) represents a pioneering procedure that circumvents ischemia-reperfusion injury to livers throughout the transplant procedure. However, its complexity has limited its widespread adoption. This study introduced a simplified ischemia-free liver transplantation (SIFLT) technique by providing an alternating flow of the portal vein and hepatic artery, demonstrating its efficacy and safety.
View Article and Find Full Text PDFRapid liver graft implantation in canine: A preliminary study.
Surg Open Sci
December 2024
Department of Geriatric Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Background: The current method for liver graft implantation during the anhepatic phase is complex. Therefore, this study aimed to introduce a modified orthotopic liver transplantation (OLT) technique with major vascular reconstruction using cuff technique to simplify the process of liver graft implantation during the anhepatic phase.
Methods: Twenty-four canines were randomly assigned to two groups: the modified orthotopic liver transplantation group (M-OLT, = 12) and the control group (n = 12).
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!