The effect of methylene blue during orthotopic liver transplantation on post reperfusion syndrome and postoperative graft function
Background/Purpose In orthotopic liver transplantation (OLT), a major component of the post-reperfusion syndrome is hypotension, which may lead to additional graft liver ischemia-reperfusion injury. A proposed mechanism of reperfusion hypotension is the massive induction of oxidative stress triggeri...
Ausführliche Beschreibung
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| Autor*in: |
Fukazawa, Kyota [verfasserIn] Pretto, Ernesto A. [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2010 |
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| Schlagwörter: |
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| Übergeordnetes Werk: |
Enthalten in: Journal of hepato-biliary pancreatic surgery - Berlin : Springer, 1993, 18(2010), 3 vom: 23. Nov., Seite 406-413 |
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| Übergeordnetes Werk: |
volume:18 ; year:2010 ; number:3 ; day:23 ; month:11 ; pages:406-413 |
| Links: |
|---|
| DOI / URN: |
10.1007/s00534-010-0344-7 |
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SPR006742580 |
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| 520 | |a Background/Purpose In orthotopic liver transplantation (OLT), a major component of the post-reperfusion syndrome is hypotension, which may lead to additional graft liver ischemia-reperfusion injury. A proposed mechanism of reperfusion hypotension is the massive induction of oxidative stress triggering the release of pro-inflammatory mediators, including nitric oxide (NO). Methylene blue (MB) is an inhibitor of inducible NO synthase and an NO scavenger that has been shown to attenuate reperfusion hypotension. Of note, recent reports have shown that the exogenous administration of NO during OLT significantly improved the recovery of the graft liver. Therefore, we sought to investigate the effects of MB on the functional recovery of the graft liver following OLT. Methods We analyzed retrospective data from 715 patients who underwent OLT between 2003 and 2008. We classified patients into those who received a 1–1.5 mg/kg intravenous bolus of MB immediately prior to reperfusion (MB group) and those who did not (control group). Propensity score matching was used to adjust for differences between patients who received intraoperative MB and those who did not, and these data were used to determine the association between a single MB bolus during OLT and postoperative graft dysfunction. Results Our study cohort consisted of 715 OLT patients, of whom 105 received MB and 610 did not. After propensity score matching, demographic and donor data were similar in the two groups, except for the older age of recipients in the MB group (55.5 ± 0.9 vs 53.1 ± 0.8 years, p = 0.026). No differences were seen in mean arterial pressure changes after reperfusion and no differences were found in vasopressor requirements (bolus or infusion) or transfusion requirements. In addition, there was no significant difference in the incidence of primary nonfunction, retransplantation within 60 days, acute rejection, or graft survival between the groups by multivariate analysis or Kaplan–Meier survival analysis. Conclusions In our study, the administration of MB at 1–1.5 mg/kg immediately prior to reperfusion did not prevent post-reperfusion hypotension and did not decrease vasopressor usage or transfusion requirements after reperfusion. Also, MB did not have any impact on postoperative graft function. These findings may argue against the routine use of MB during OLT. | ||
| 650 | 4 | |a Liver transplantation |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Methylene blue |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Reperfusion |7 (dpeaa)DE-He213 | |
| 650 | 4 | |a Graft function |7 (dpeaa)DE-He213 | |
| 700 | 1 | |a Pretto, Ernesto A. |e verfasserin |4 aut | |
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10.1007/s00534-010-0344-7 doi (DE-627)SPR006742580 (SPR)s00534-010-0344-7-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.87 bkl Fukazawa, Kyota verfasserin aut The effect of methylene blue during orthotopic liver transplantation on post reperfusion syndrome and postoperative graft function 2010 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background/Purpose In orthotopic liver transplantation (OLT), a major component of the post-reperfusion syndrome is hypotension, which may lead to additional graft liver ischemia-reperfusion injury. A proposed mechanism of reperfusion hypotension is the massive induction of oxidative stress triggering the release of pro-inflammatory mediators, including nitric oxide (NO). Methylene blue (MB) is an inhibitor of inducible NO synthase and an NO scavenger that has been shown to attenuate reperfusion hypotension. Of note, recent reports have shown that the exogenous administration of NO during OLT significantly improved the recovery of the graft liver. Therefore, we sought to investigate the effects of MB on the functional recovery of the graft liver following OLT. Methods We analyzed retrospective data from 715 patients who underwent OLT between 2003 and 2008. We classified patients into those who received a 1–1.5 mg/kg intravenous bolus of MB immediately prior to reperfusion (MB group) and those who did not (control group). Propensity score matching was used to adjust for differences between patients who received intraoperative MB and those who did not, and these data were used to determine the association between a single MB bolus during OLT and postoperative graft dysfunction. Results Our study cohort consisted of 715 OLT patients, of whom 105 received MB and 610 did not. After propensity score matching, demographic and donor data were similar in the two groups, except for the older age of recipients in the MB group (55.5 ± 0.9 vs 53.1 ± 0.8 years, p = 0.026). No differences were seen in mean arterial pressure changes after reperfusion and no differences were found in vasopressor requirements (bolus or infusion) or transfusion requirements. In addition, there was no significant difference in the incidence of primary nonfunction, retransplantation within 60 days, acute rejection, or graft survival between the groups by multivariate analysis or Kaplan–Meier survival analysis. Conclusions In our study, the administration of MB at 1–1.5 mg/kg immediately prior to reperfusion did not prevent post-reperfusion hypotension and did not decrease vasopressor usage or transfusion requirements after reperfusion. Also, MB did not have any impact on postoperative graft function. These findings may argue against the routine use of MB during OLT. Liver transplantation (dpeaa)DE-He213 Methylene blue (dpeaa)DE-He213 Reperfusion (dpeaa)DE-He213 Graft function (dpeaa)DE-He213 Pretto, Ernesto A. verfasserin aut Enthalten in Journal of hepato-biliary pancreatic surgery Berlin : Springer, 1993 18(2010), 3 vom: 23. Nov., Seite 406-413 (DE-627)268761701 (DE-600)1473162-9 1436-0691 nnns volume:18 year:2010 number:3 day:23 month:11 pages:406-413 https://dx.doi.org/10.1007/s00534-010-0344-7 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_40 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_110 GBV_ILN_120 GBV_ILN_267 GBV_ILN_285 GBV_ILN_647 GBV_ILN_702 44.87 ASE AR 18 2010 3 23 11 406-413 |
| spelling |
10.1007/s00534-010-0344-7 doi (DE-627)SPR006742580 (SPR)s00534-010-0344-7-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.87 bkl Fukazawa, Kyota verfasserin aut The effect of methylene blue during orthotopic liver transplantation on post reperfusion syndrome and postoperative graft function 2010 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background/Purpose In orthotopic liver transplantation (OLT), a major component of the post-reperfusion syndrome is hypotension, which may lead to additional graft liver ischemia-reperfusion injury. A proposed mechanism of reperfusion hypotension is the massive induction of oxidative stress triggering the release of pro-inflammatory mediators, including nitric oxide (NO). Methylene blue (MB) is an inhibitor of inducible NO synthase and an NO scavenger that has been shown to attenuate reperfusion hypotension. Of note, recent reports have shown that the exogenous administration of NO during OLT significantly improved the recovery of the graft liver. Therefore, we sought to investigate the effects of MB on the functional recovery of the graft liver following OLT. Methods We analyzed retrospective data from 715 patients who underwent OLT between 2003 and 2008. We classified patients into those who received a 1–1.5 mg/kg intravenous bolus of MB immediately prior to reperfusion (MB group) and those who did not (control group). Propensity score matching was used to adjust for differences between patients who received intraoperative MB and those who did not, and these data were used to determine the association between a single MB bolus during OLT and postoperative graft dysfunction. Results Our study cohort consisted of 715 OLT patients, of whom 105 received MB and 610 did not. After propensity score matching, demographic and donor data were similar in the two groups, except for the older age of recipients in the MB group (55.5 ± 0.9 vs 53.1 ± 0.8 years, p = 0.026). No differences were seen in mean arterial pressure changes after reperfusion and no differences were found in vasopressor requirements (bolus or infusion) or transfusion requirements. In addition, there was no significant difference in the incidence of primary nonfunction, retransplantation within 60 days, acute rejection, or graft survival between the groups by multivariate analysis or Kaplan–Meier survival analysis. Conclusions In our study, the administration of MB at 1–1.5 mg/kg immediately prior to reperfusion did not prevent post-reperfusion hypotension and did not decrease vasopressor usage or transfusion requirements after reperfusion. Also, MB did not have any impact on postoperative graft function. These findings may argue against the routine use of MB during OLT. Liver transplantation (dpeaa)DE-He213 Methylene blue (dpeaa)DE-He213 Reperfusion (dpeaa)DE-He213 Graft function (dpeaa)DE-He213 Pretto, Ernesto A. verfasserin aut Enthalten in Journal of hepato-biliary pancreatic surgery Berlin : Springer, 1993 18(2010), 3 vom: 23. Nov., Seite 406-413 (DE-627)268761701 (DE-600)1473162-9 1436-0691 nnns volume:18 year:2010 number:3 day:23 month:11 pages:406-413 https://dx.doi.org/10.1007/s00534-010-0344-7 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_40 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_110 GBV_ILN_120 GBV_ILN_267 GBV_ILN_285 GBV_ILN_647 GBV_ILN_702 44.87 ASE AR 18 2010 3 23 11 406-413 |
| allfields_unstemmed |
10.1007/s00534-010-0344-7 doi (DE-627)SPR006742580 (SPR)s00534-010-0344-7-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.87 bkl Fukazawa, Kyota verfasserin aut The effect of methylene blue during orthotopic liver transplantation on post reperfusion syndrome and postoperative graft function 2010 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background/Purpose In orthotopic liver transplantation (OLT), a major component of the post-reperfusion syndrome is hypotension, which may lead to additional graft liver ischemia-reperfusion injury. A proposed mechanism of reperfusion hypotension is the massive induction of oxidative stress triggering the release of pro-inflammatory mediators, including nitric oxide (NO). Methylene blue (MB) is an inhibitor of inducible NO synthase and an NO scavenger that has been shown to attenuate reperfusion hypotension. Of note, recent reports have shown that the exogenous administration of NO during OLT significantly improved the recovery of the graft liver. Therefore, we sought to investigate the effects of MB on the functional recovery of the graft liver following OLT. Methods We analyzed retrospective data from 715 patients who underwent OLT between 2003 and 2008. We classified patients into those who received a 1–1.5 mg/kg intravenous bolus of MB immediately prior to reperfusion (MB group) and those who did not (control group). Propensity score matching was used to adjust for differences between patients who received intraoperative MB and those who did not, and these data were used to determine the association between a single MB bolus during OLT and postoperative graft dysfunction. Results Our study cohort consisted of 715 OLT patients, of whom 105 received MB and 610 did not. After propensity score matching, demographic and donor data were similar in the two groups, except for the older age of recipients in the MB group (55.5 ± 0.9 vs 53.1 ± 0.8 years, p = 0.026). No differences were seen in mean arterial pressure changes after reperfusion and no differences were found in vasopressor requirements (bolus or infusion) or transfusion requirements. In addition, there was no significant difference in the incidence of primary nonfunction, retransplantation within 60 days, acute rejection, or graft survival between the groups by multivariate analysis or Kaplan–Meier survival analysis. Conclusions In our study, the administration of MB at 1–1.5 mg/kg immediately prior to reperfusion did not prevent post-reperfusion hypotension and did not decrease vasopressor usage or transfusion requirements after reperfusion. Also, MB did not have any impact on postoperative graft function. These findings may argue against the routine use of MB during OLT. Liver transplantation (dpeaa)DE-He213 Methylene blue (dpeaa)DE-He213 Reperfusion (dpeaa)DE-He213 Graft function (dpeaa)DE-He213 Pretto, Ernesto A. verfasserin aut Enthalten in Journal of hepato-biliary pancreatic surgery Berlin : Springer, 1993 18(2010), 3 vom: 23. Nov., Seite 406-413 (DE-627)268761701 (DE-600)1473162-9 1436-0691 nnns volume:18 year:2010 number:3 day:23 month:11 pages:406-413 https://dx.doi.org/10.1007/s00534-010-0344-7 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_40 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_110 GBV_ILN_120 GBV_ILN_267 GBV_ILN_285 GBV_ILN_647 GBV_ILN_702 44.87 ASE AR 18 2010 3 23 11 406-413 |
| allfieldsGer |
10.1007/s00534-010-0344-7 doi (DE-627)SPR006742580 (SPR)s00534-010-0344-7-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.87 bkl Fukazawa, Kyota verfasserin aut The effect of methylene blue during orthotopic liver transplantation on post reperfusion syndrome and postoperative graft function 2010 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background/Purpose In orthotopic liver transplantation (OLT), a major component of the post-reperfusion syndrome is hypotension, which may lead to additional graft liver ischemia-reperfusion injury. A proposed mechanism of reperfusion hypotension is the massive induction of oxidative stress triggering the release of pro-inflammatory mediators, including nitric oxide (NO). Methylene blue (MB) is an inhibitor of inducible NO synthase and an NO scavenger that has been shown to attenuate reperfusion hypotension. Of note, recent reports have shown that the exogenous administration of NO during OLT significantly improved the recovery of the graft liver. Therefore, we sought to investigate the effects of MB on the functional recovery of the graft liver following OLT. Methods We analyzed retrospective data from 715 patients who underwent OLT between 2003 and 2008. We classified patients into those who received a 1–1.5 mg/kg intravenous bolus of MB immediately prior to reperfusion (MB group) and those who did not (control group). Propensity score matching was used to adjust for differences between patients who received intraoperative MB and those who did not, and these data were used to determine the association between a single MB bolus during OLT and postoperative graft dysfunction. Results Our study cohort consisted of 715 OLT patients, of whom 105 received MB and 610 did not. After propensity score matching, demographic and donor data were similar in the two groups, except for the older age of recipients in the MB group (55.5 ± 0.9 vs 53.1 ± 0.8 years, p = 0.026). No differences were seen in mean arterial pressure changes after reperfusion and no differences were found in vasopressor requirements (bolus or infusion) or transfusion requirements. In addition, there was no significant difference in the incidence of primary nonfunction, retransplantation within 60 days, acute rejection, or graft survival between the groups by multivariate analysis or Kaplan–Meier survival analysis. Conclusions In our study, the administration of MB at 1–1.5 mg/kg immediately prior to reperfusion did not prevent post-reperfusion hypotension and did not decrease vasopressor usage or transfusion requirements after reperfusion. Also, MB did not have any impact on postoperative graft function. These findings may argue against the routine use of MB during OLT. Liver transplantation (dpeaa)DE-He213 Methylene blue (dpeaa)DE-He213 Reperfusion (dpeaa)DE-He213 Graft function (dpeaa)DE-He213 Pretto, Ernesto A. verfasserin aut Enthalten in Journal of hepato-biliary pancreatic surgery Berlin : Springer, 1993 18(2010), 3 vom: 23. Nov., Seite 406-413 (DE-627)268761701 (DE-600)1473162-9 1436-0691 nnns volume:18 year:2010 number:3 day:23 month:11 pages:406-413 https://dx.doi.org/10.1007/s00534-010-0344-7 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_40 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_110 GBV_ILN_120 GBV_ILN_267 GBV_ILN_285 GBV_ILN_647 GBV_ILN_702 44.87 ASE AR 18 2010 3 23 11 406-413 |
| allfieldsSound |
10.1007/s00534-010-0344-7 doi (DE-627)SPR006742580 (SPR)s00534-010-0344-7-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE 44.87 bkl Fukazawa, Kyota verfasserin aut The effect of methylene blue during orthotopic liver transplantation on post reperfusion syndrome and postoperative graft function 2010 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background/Purpose In orthotopic liver transplantation (OLT), a major component of the post-reperfusion syndrome is hypotension, which may lead to additional graft liver ischemia-reperfusion injury. A proposed mechanism of reperfusion hypotension is the massive induction of oxidative stress triggering the release of pro-inflammatory mediators, including nitric oxide (NO). Methylene blue (MB) is an inhibitor of inducible NO synthase and an NO scavenger that has been shown to attenuate reperfusion hypotension. Of note, recent reports have shown that the exogenous administration of NO during OLT significantly improved the recovery of the graft liver. Therefore, we sought to investigate the effects of MB on the functional recovery of the graft liver following OLT. Methods We analyzed retrospective data from 715 patients who underwent OLT between 2003 and 2008. We classified patients into those who received a 1–1.5 mg/kg intravenous bolus of MB immediately prior to reperfusion (MB group) and those who did not (control group). Propensity score matching was used to adjust for differences between patients who received intraoperative MB and those who did not, and these data were used to determine the association between a single MB bolus during OLT and postoperative graft dysfunction. Results Our study cohort consisted of 715 OLT patients, of whom 105 received MB and 610 did not. After propensity score matching, demographic and donor data were similar in the two groups, except for the older age of recipients in the MB group (55.5 ± 0.9 vs 53.1 ± 0.8 years, p = 0.026). No differences were seen in mean arterial pressure changes after reperfusion and no differences were found in vasopressor requirements (bolus or infusion) or transfusion requirements. In addition, there was no significant difference in the incidence of primary nonfunction, retransplantation within 60 days, acute rejection, or graft survival between the groups by multivariate analysis or Kaplan–Meier survival analysis. Conclusions In our study, the administration of MB at 1–1.5 mg/kg immediately prior to reperfusion did not prevent post-reperfusion hypotension and did not decrease vasopressor usage or transfusion requirements after reperfusion. Also, MB did not have any impact on postoperative graft function. These findings may argue against the routine use of MB during OLT. Liver transplantation (dpeaa)DE-He213 Methylene blue (dpeaa)DE-He213 Reperfusion (dpeaa)DE-He213 Graft function (dpeaa)DE-He213 Pretto, Ernesto A. verfasserin aut Enthalten in Journal of hepato-biliary pancreatic surgery Berlin : Springer, 1993 18(2010), 3 vom: 23. Nov., Seite 406-413 (DE-627)268761701 (DE-600)1473162-9 1436-0691 nnns volume:18 year:2010 number:3 day:23 month:11 pages:406-413 https://dx.doi.org/10.1007/s00534-010-0344-7 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_40 GBV_ILN_62 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_110 GBV_ILN_120 GBV_ILN_267 GBV_ILN_285 GBV_ILN_647 GBV_ILN_702 44.87 ASE AR 18 2010 3 23 11 406-413 |
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A proposed mechanism of reperfusion hypotension is the massive induction of oxidative stress triggering the release of pro-inflammatory mediators, including nitric oxide (NO). Methylene blue (MB) is an inhibitor of inducible NO synthase and an NO scavenger that has been shown to attenuate reperfusion hypotension. Of note, recent reports have shown that the exogenous administration of NO during OLT significantly improved the recovery of the graft liver. Therefore, we sought to investigate the effects of MB on the functional recovery of the graft liver following OLT. Methods We analyzed retrospective data from 715 patients who underwent OLT between 2003 and 2008. We classified patients into those who received a 1–1.5 mg/kg intravenous bolus of MB immediately prior to reperfusion (MB group) and those who did not (control group). Propensity score matching was used to adjust for differences between patients who received intraoperative MB and those who did not, and these data were used to determine the association between a single MB bolus during OLT and postoperative graft dysfunction. Results Our study cohort consisted of 715 OLT patients, of whom 105 received MB and 610 did not. After propensity score matching, demographic and donor data were similar in the two groups, except for the older age of recipients in the MB group (55.5 ± 0.9 vs 53.1 ± 0.8 years, p = 0.026). No differences were seen in mean arterial pressure changes after reperfusion and no differences were found in vasopressor requirements (bolus or infusion) or transfusion requirements. In addition, there was no significant difference in the incidence of primary nonfunction, retransplantation within 60 days, acute rejection, or graft survival between the groups by multivariate analysis or Kaplan–Meier survival analysis. Conclusions In our study, the administration of MB at 1–1.5 mg/kg immediately prior to reperfusion did not prevent post-reperfusion hypotension and did not decrease vasopressor usage or transfusion requirements after reperfusion. Also, MB did not have any impact on postoperative graft function. 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Fukazawa, Kyota |
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610 ASE 44.87 bkl The effect of methylene blue during orthotopic liver transplantation on post reperfusion syndrome and postoperative graft function Liver transplantation (dpeaa)DE-He213 Methylene blue (dpeaa)DE-He213 Reperfusion (dpeaa)DE-He213 Graft function (dpeaa)DE-He213 |
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effect of methylene blue during orthotopic liver transplantation on post reperfusion syndrome and postoperative graft function |
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The effect of methylene blue during orthotopic liver transplantation on post reperfusion syndrome and postoperative graft function |
| abstract |
Background/Purpose In orthotopic liver transplantation (OLT), a major component of the post-reperfusion syndrome is hypotension, which may lead to additional graft liver ischemia-reperfusion injury. A proposed mechanism of reperfusion hypotension is the massive induction of oxidative stress triggering the release of pro-inflammatory mediators, including nitric oxide (NO). Methylene blue (MB) is an inhibitor of inducible NO synthase and an NO scavenger that has been shown to attenuate reperfusion hypotension. Of note, recent reports have shown that the exogenous administration of NO during OLT significantly improved the recovery of the graft liver. Therefore, we sought to investigate the effects of MB on the functional recovery of the graft liver following OLT. Methods We analyzed retrospective data from 715 patients who underwent OLT between 2003 and 2008. We classified patients into those who received a 1–1.5 mg/kg intravenous bolus of MB immediately prior to reperfusion (MB group) and those who did not (control group). Propensity score matching was used to adjust for differences between patients who received intraoperative MB and those who did not, and these data were used to determine the association between a single MB bolus during OLT and postoperative graft dysfunction. Results Our study cohort consisted of 715 OLT patients, of whom 105 received MB and 610 did not. After propensity score matching, demographic and donor data were similar in the two groups, except for the older age of recipients in the MB group (55.5 ± 0.9 vs 53.1 ± 0.8 years, p = 0.026). No differences were seen in mean arterial pressure changes after reperfusion and no differences were found in vasopressor requirements (bolus or infusion) or transfusion requirements. In addition, there was no significant difference in the incidence of primary nonfunction, retransplantation within 60 days, acute rejection, or graft survival between the groups by multivariate analysis or Kaplan–Meier survival analysis. Conclusions In our study, the administration of MB at 1–1.5 mg/kg immediately prior to reperfusion did not prevent post-reperfusion hypotension and did not decrease vasopressor usage or transfusion requirements after reperfusion. Also, MB did not have any impact on postoperative graft function. These findings may argue against the routine use of MB during OLT. |
| abstractGer |
Background/Purpose In orthotopic liver transplantation (OLT), a major component of the post-reperfusion syndrome is hypotension, which may lead to additional graft liver ischemia-reperfusion injury. A proposed mechanism of reperfusion hypotension is the massive induction of oxidative stress triggering the release of pro-inflammatory mediators, including nitric oxide (NO). Methylene blue (MB) is an inhibitor of inducible NO synthase and an NO scavenger that has been shown to attenuate reperfusion hypotension. Of note, recent reports have shown that the exogenous administration of NO during OLT significantly improved the recovery of the graft liver. Therefore, we sought to investigate the effects of MB on the functional recovery of the graft liver following OLT. Methods We analyzed retrospective data from 715 patients who underwent OLT between 2003 and 2008. We classified patients into those who received a 1–1.5 mg/kg intravenous bolus of MB immediately prior to reperfusion (MB group) and those who did not (control group). Propensity score matching was used to adjust for differences between patients who received intraoperative MB and those who did not, and these data were used to determine the association between a single MB bolus during OLT and postoperative graft dysfunction. Results Our study cohort consisted of 715 OLT patients, of whom 105 received MB and 610 did not. After propensity score matching, demographic and donor data were similar in the two groups, except for the older age of recipients in the MB group (55.5 ± 0.9 vs 53.1 ± 0.8 years, p = 0.026). No differences were seen in mean arterial pressure changes after reperfusion and no differences were found in vasopressor requirements (bolus or infusion) or transfusion requirements. In addition, there was no significant difference in the incidence of primary nonfunction, retransplantation within 60 days, acute rejection, or graft survival between the groups by multivariate analysis or Kaplan–Meier survival analysis. Conclusions In our study, the administration of MB at 1–1.5 mg/kg immediately prior to reperfusion did not prevent post-reperfusion hypotension and did not decrease vasopressor usage or transfusion requirements after reperfusion. Also, MB did not have any impact on postoperative graft function. These findings may argue against the routine use of MB during OLT. |
| abstract_unstemmed |
Background/Purpose In orthotopic liver transplantation (OLT), a major component of the post-reperfusion syndrome is hypotension, which may lead to additional graft liver ischemia-reperfusion injury. A proposed mechanism of reperfusion hypotension is the massive induction of oxidative stress triggering the release of pro-inflammatory mediators, including nitric oxide (NO). Methylene blue (MB) is an inhibitor of inducible NO synthase and an NO scavenger that has been shown to attenuate reperfusion hypotension. Of note, recent reports have shown that the exogenous administration of NO during OLT significantly improved the recovery of the graft liver. Therefore, we sought to investigate the effects of MB on the functional recovery of the graft liver following OLT. Methods We analyzed retrospective data from 715 patients who underwent OLT between 2003 and 2008. We classified patients into those who received a 1–1.5 mg/kg intravenous bolus of MB immediately prior to reperfusion (MB group) and those who did not (control group). Propensity score matching was used to adjust for differences between patients who received intraoperative MB and those who did not, and these data were used to determine the association between a single MB bolus during OLT and postoperative graft dysfunction. Results Our study cohort consisted of 715 OLT patients, of whom 105 received MB and 610 did not. After propensity score matching, demographic and donor data were similar in the two groups, except for the older age of recipients in the MB group (55.5 ± 0.9 vs 53.1 ± 0.8 years, p = 0.026). No differences were seen in mean arterial pressure changes after reperfusion and no differences were found in vasopressor requirements (bolus or infusion) or transfusion requirements. In addition, there was no significant difference in the incidence of primary nonfunction, retransplantation within 60 days, acute rejection, or graft survival between the groups by multivariate analysis or Kaplan–Meier survival analysis. Conclusions In our study, the administration of MB at 1–1.5 mg/kg immediately prior to reperfusion did not prevent post-reperfusion hypotension and did not decrease vasopressor usage or transfusion requirements after reperfusion. Also, MB did not have any impact on postoperative graft function. These findings may argue against the routine use of MB during OLT. |
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Propensity score matching was used to adjust for differences between patients who received intraoperative MB and those who did not, and these data were used to determine the association between a single MB bolus during OLT and postoperative graft dysfunction. Results Our study cohort consisted of 715 OLT patients, of whom 105 received MB and 610 did not. After propensity score matching, demographic and donor data were similar in the two groups, except for the older age of recipients in the MB group (55.5 ± 0.9 vs 53.1 ± 0.8 years, p = 0.026). No differences were seen in mean arterial pressure changes after reperfusion and no differences were found in vasopressor requirements (bolus or infusion) or transfusion requirements. In addition, there was no significant difference in the incidence of primary nonfunction, retransplantation within 60 days, acute rejection, or graft survival between the groups by multivariate analysis or Kaplan–Meier survival analysis. 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