Hyperbaric oxygen therapy for hepatic artery thrombosis after liver transplantation in children

被引:34
作者
Mazariegos, GV
O'Toole, K
Mieles, LA
Dvorchik, I
Meza, M
Briassoulis, G
Arzate, J
Osorio, G
Fung, JJ
Reyes, J
机构
[1] Univ Pittsburgh, Med Ctr, Dept Surg, Thomas E Starzl Transplantat Inst, Pittsburgh, PA USA
[2] Univ Pittsburgh, Med Ctr, Dept Emergency Med, Pittsburgh, PA USA
[3] Childrens Hosp Pittsburgh, Dept Radiol, Pittsburgh, PA 15213 USA
[4] Univ Rochester, Strong Mem Hosp, Rochester, NY 14642 USA
来源
LIVER TRANSPLANTATION AND SURGERY | 1999年 / 5卷 / 05期
关键词
D O I
10.1002/lt.500050518
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Early hepatic artery thrombosis (HAT) after pediatric orthotopic liver transplantation (OLT) can cause significant morbidity and mortality, leading to liver failure or septic complications requiring urgent retransplantation. Experimental evidence that hyperbaric oxygen (HBO) may ameliorate hepatic ischemic-reperfusion injury led to this study of HBO in pediatric liver transplant recipients who developed HAT. Children undergoing OLT under primary tacrolimus immunosuppression and University of Wisconsin organ preservation between August 1, 1989, and December 31, 1998, who developed HAT were the basis for this study. Patients who developed HAT between March 1, 1994, and December 31, 1998, were treated with HBO therapy until signs of ischemia resolved (absence of fever, normalizing liver injury test results) or for 2 weeks. The pediatric OLTs performed from August 1, 1989, to February 28, 1994, who developed HAT served as a control group. Primary outcome measures were survival, retransplantation rate, time to retransplantation, incidence of hepatic gangrene, and days to collateral formation. Three hundred seventy-five consecutive pediatric patients underwent 416 OLTs between August 1, 1989, and December 31, 1998. Thirty-one patients (7.5%) developed HAT at a mean time of 8.2 days (range, 1 to 52 days) post-OLT: In 17 patients, HBO treatment was begun within 24 hours of HAT or immediately after the revascularization attempt and performed twice daily for 90 minutes at 2.4 atmospheres pressure. Fourteen patients were treated without HBO. None of the HBO-treated patients developed hepatic gangrene. Eight HBO patients (47%) were bridged to retransplantation at a mean time of 157 days (range, 3 to 952 days) after initial OLT and all survived. Mean time to retransplant in the control group was 12.7 days (range, 1 to 64 days). HBO was well tolerated without significant complications. Although there was no significant difference in survival or retransplantation rates, HBO significantly delayed retransplantation, potentially by hastening the development of hepatic artery collaterals. Copyright (C) 1999 by the American Association for the Study of Liver Diseases.
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页码:429 / 436
页数:8
相关论文
共 35 条
[1]  
Bassett BE, 1977, HYPERBARIC OXYGEN TH, P11
[2]  
Boerema I., 1960, Nederlands tijdschrift voor geneeskunde, V104, P949
[3]  
BRETTSCH.L, 1968, SURG GYNECOL OBSTETR, V126, P263
[4]  
BRETTSCHNEIDER L, 1969, TRANSPL P, V1, P132
[5]   LIVER-TRANSPLANTATION IN CHILDREN [J].
BUSUTTIL, RW ;
SEU, P ;
MILLIS, JM ;
OLTHOFF, KM ;
HIATT, JR ;
MILEWICZ, A ;
NUESSE, B ;
ELKHOURY, G ;
RAYBOULD, D ;
NYERGES, A ;
VARGAS, J ;
MCDIARMID, S ;
BERQUIST, W ;
HARRISON, R ;
AMENT, M .
ANNALS OF SURGERY, 1991, 213 (01) :48-57
[6]   EFFECT OF HYPERBARIC OXYGEN ON SURVIVAL OF PEDICLED SKIN FLAPS [J].
CHAMPION, WM ;
MCSHERRY, CK ;
GOULIAN, D .
JOURNAL OF SURGICAL RESEARCH, 1967, 7 (12) :583-&
[7]  
Chen MF, 1998, LIVER, V18, P110
[8]  
Drazan K, 1996, AM SURGEON, V62, P237
[9]  
GRIM PS, 1990, JAMA-J AM MED ASSOC, V263, P2216
[10]  
Hohn DC, 1977, HYPERBARIC OXYGEN TH, P101