Dana R Tomescu1,2, Simona Olimpia Dima3, Daniela Ungureanu4, Mihai Popescu2, Dan Tulbure2,4, Irinel Popescu2,3. 1. Department of Anesthesiology and Critical Care III, Fundeni Clinical Institute, Bucharest - Romania. 2. University of Medicine and Pharmacy "Carol Davila", Bucharest - Romania. 3. Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest - Romania. 4. Department of Anesthesiology and Critical Care I, Fundeni Clinical Institute, Bucharest - Romania.
Abstract
INTRODUCTION: Emergency transplantation of a donor liver that is not matched for the major blood antigens can produce marked immune-mediated cytokine release that can cause donor graft loss. Control of the inflammatory response may be a key element in treatment. METHODS: We present the case of a 46-year-old man with primary graft nonfunction after liver transplantation who underwent emergency retransplantation with an ABO-incompatible graft. A severe inflammatory response syndrome (SIRS) was noted in the perioperioperative period of retransplantation. The patient was successfully treated for this condition with a new hemoadsorption column (CytoSorb®), in combination with continuous venovenous hemofiltration (CVVH) throughout the intraoperative and early postoperative period. RESULTS: During and after each treatment a significant and rapid decrease of pro- and anti-inflammatory cytokines was observed, especially for interleukin-6 (IL-6), IL-10 and monocyte chemotactic protein 1 (MCP-1). Reduction of cytokines was associated with normalization of cardiac output and systemic vascular resistance, and improved liver function. CONCLUSIONS: We believe this is the first case in which hemoadsorptionin combination with CVVH has been used to manage SIRS in a patient with primary graft nonfunction undergoing emergency retransplantation.
INTRODUCTION: Emergency transplantation of a donor liver that is not matched for the major blood antigens can produce marked immune-mediated cytokine release that can cause donor graft loss. Control of the inflammatory response may be a key element in treatment. METHODS: We present the case of a 46-year-old man with primary graft nonfunction after liver transplantation who underwent emergency retransplantation with an ABO-incompatible graft. A severe inflammatory response syndrome (SIRS) was noted in the perioperioperative period of retransplantation. The patient was successfully treated for this condition with a new hemoadsorption column (CytoSorb®), in combination with continuous venovenous hemofiltration (CVVH) throughout the intraoperative and early postoperative period. RESULTS: During and after each treatment a significant and rapid decrease of pro- and anti-inflammatory cytokines was observed, especially for interleukin-6 (IL-6), IL-10 and monocyte chemotactic protein 1 (MCP-1). Reduction of cytokines was associated with normalization of cardiac output and systemic vascular resistance, and improved liver function. CONCLUSIONS: We believe this is the first case in which hemoadsorptionin combination with CVVH has been used to manage SIRS in a patient with primary graft nonfunction undergoing emergency retransplantation.
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