Mjh Slooff

Reduced transfusion requirements by recombinant factor VIIa in orthotopic liver transplantation : A pilot study

Background. Large transfusion requirements, i.e., excessive blood loss, during orthotopic liver transplantation (OLT) are correlated with increased morbidity and mortality. Recombinant factor VIIa (rFVIIa) has been shown to improve hemostasis in a variety of conditions, but has never been studied in liver transplantation. Methods. We performed a single-center, open-label, pilot study in adult patients undergoing OLT for cirrhosis Child-Pugh B or C, to assess efficacy and safety of rFVIIa. rFVIIa (80 &mgr;g/kg) was administered at the start of the operation, to be repeated according to predefined criteria. Packed red blood cells (RBC), fresh-frozen plasma, and platelet concentrates were administered according to predefined criteria. Perioperative transfusion requirements in study patients were compared with matched controls. Results. Six patients were enrolled in the study. All received a single dose of rFVIIa. Transfusion requirements (given as median, with range in parentheses) were lower in the study group than in matched controls: 1.5 (0–5) vs. 7 (2–18) units of allogeneic RBC (P =0.006), 0 (0–2) vs. 3.5 (0–23) units of autologous RBC (P =0.043), total amount of RBC 3 (0–5) vs. 9 (4–40) units (P =0.002). Transfused fresh-frozen plasma was 1 (0–7) vs. 8 (2–35) units (P =0.011). Blood loss was 3.5 L (1.4–5.3) vs. 9.8 L (3.7–35.0) (P =0.004). One study patient developed a hepatic artery thrombosis at day 1 postoperatively. Conclusions. A single dose of 80 &mgr;g/kg rFVIIa significantly reduced transfusion requirements during OLT. Further study is needed to establish the optimally effective and safe dose of rFVIIa in orthotopic liver transplantation.

Hyperkalaemia after radiofrequency ablation of hepatocellular carcinoma

Radiofrequency ablation of liver tumours is a useful therapy for otherwise unresectable tumours. The complication rate is said to be low. In this case report we describe hyperkalaemia after radiofrequency ablation of a hepatocellular carcinoma in a patient with end-stage renal insufficiency.

One-step method for endothelial cell isolation from large human blood vessels using fibrin glue

solation of endothelial cells (EC) from large humanblood vessels obtained from multi-organ donorscannot be performed as described for human umbili-cal cords (Jaffe et al, 1973) because of the availabilityof only small segments with side branches and inci-sions. We isolated EC from segments of human iliacarteries and veins with collagenase while the adventi-tia side of the vessels was attached to the culture dishwith fibrin glue. This prevented the collagenase frommaking contact with the adventitia side, resulting in ahigh yield of EC with minimized contamination of cellsfrom nonendothelial origin.Iliac arteries and veins from multiorgan donors werestored in cold preservation solution (UW) until 7 daysafter liver transplantation. Before isolation of EC, atissue sample of 100 mm