Showing papers by "Brian R. Davidson published in 1997"
TL;DR: Background Laser Doppler flowmetry can measure blood flow in the hepatic microcirculation and has not previously been measured during operation in liver transplant recipients.
Abstract: Background Laser Doppler flowmetry (LDF) can measure blood flow in the hepatic microcirculation. Adequate graft perfusion is essential to the outcome of organ transplantation and has not previously been measured during operation in liver transplant recipients.Methods LDF was carried out during operation in 22 human liver grafts after restoring portal vein and hepatic artery inflow. LDF readings were validated against liver blood flow with an electromagnetic flowmeter. Intraoperative haemodynamics and donor organ parameters known to influence graft function were correlated with LDF.Results There was a significant correlation (r = 0.96, P < 0.001) between hepatic perfusion determined with LDF and total liver blood flow measured by electromagnetic flowmetry. The perfusion measurements were reproducible with a coefficient of variation of 4 per cent. Mean(s.d.) hepatic perfusion increased significantly from baseline following venous reperfusion (17(6) versus 114(37) flux units, P < 0.001). Arterial revascularization resulted in a significant increase in mean(s.d.) perfusion (32(4) per cent, P = 0.02). There was a significant negative correlation between cold ischaemia time and graft perfusion (r = 0.48, P = 0.02; n = 22).Conclusion LDF provides a reliable non-invasive method of monitoring liver graft blood flow perfusion during transplantation.
63 citations
TL;DR: The capacity of the liver to regenerate adenosine triphosphate following a 24-h period of cold storage was reduced by approximately 40% of the total amount achieved following the shorter cold storage time.
47 citations
TL;DR: IOCT is an insensitive method for the detection of small HCCs in livers with advanced cirrhosis but in this study was slightly superior to ultrasound, CT, and angiography.
Abstract: Background—The detection of hepatocellular cancers (HCC) is a major role of preoperative imaging in patients with end stage liver disease being considered for orthotopic liver transplantation (OLT).
Aims—To assess the sensitivity of iodised oil computed tomography (IOCT).
Patients and methods—A prospective evaluation in 50 consecutive patients undergoing OLT included ultrasound scan, contrast enhanced CT, angiography (with intra-arterial injection of iodised oil), and a second CT (IOCT) 10 days later. Following transplantation the explant liver was serially sectioned for pathological evaluation. Soft tissue radiographs of the liver slices were used to match histological lesions with CT findings.
Results—Eleven patients were excluded due to protocol violations. Of the remaining 39, histological evaluation revealed no cancers in 33 explant livers, in keeping with negative preoperative imaging. Six explant livers contained 55 HCCs, 84% of which were less than 1 cm in diameter. Pretransplant IOCT detected 3/6 patients with cancer (50%) but only 7% of cancerous lesions. Ultrasound, contrast CT, and angiography each detected 2/6 patients with cancer and 4% of cancerous lesions.
Conclusion—IOCT is an insensitive method for the detection of small HCCs in livers with advanced cirrhosis but in this study was slightly superior to ultrasound, CT, and angiography.
Keywords: liver cirrhosis; transplantation; hepatocellular carcinoma; iodised oil; computed tomography
31 citations
TL;DR: Sampling according to predetermined macroscopic criteria proved an effective method for identifying small HCCs: 44 cancers were detected, most < 5 mm in diameter, additional to those picked up on routine assessment, and green nodules were more likely to be HCC.
25 citations
TL;DR: In recent large animal studies MRS has been developed to provide continuous dynamic information on ATP metabolism during graft reperfusion and the bioenergetic consequences of altering preservation solutions and needs to be critically evaluated in human liver transplantation.
24 citations
TL;DR: Quantitative artificial neural network analysis for 1550 ex vivo 31P nuclear magnetic resonance spectra from hypothermically reperfused pig livers showed high correlations and was able to fully represent the trends in the metabolic fluctuations during the experiments.
Abstract: Quantitative artificial neural network analysis for 1550 ex vivo31P nuclear magnetic resonance spectra from hypothermically reperfused pig livers was assessed. These spectra show wide ranges of metabolite concentrations and have been analyzed using metabolite prior knowledge based lineshape fitting analysis which had proved robust in its biochemical interpretation. This finding provided a good opportunity to assess the performance of artificial neural network analysis in a biochemically complex situation. The results showed high correlations (0.8655 ≤ R ≤ 0.992) between the lineshape fitting and artificial neural network analysis for the metabolite values, and the artificial neural network analysis was able to fully represent the trends in the metabolic fluctuations during the experiments.
17 citations
5 citations
TL;DR: Transjugular intrahepatic portasystemic shunt is now considered as an option for the control of intractable variceal bleeding because of the high incidence of stenosis and occlusion.
Abstract: Transjugular intrahepatic portasystemic shunt (TIPS) is now considered as an option for the control of intractable variceal bleeding1. The high incidence of stenosis and occlusion (50 per cent significant stenosis at 6 months2) favours its use as a bridge to more definitive therapy such as surgical shunting or orthotopic liver transplantation (OLT). The specific difficulties presented to the surgeon by the metal stent have not been considered, although they have been reported anecdotally'. The surgical comp!ications of TIPS insertion have been reviewed.
5 citations
4 citations
TL;DR: In this paper, the results of steroid withdrawal from long-term immunosuppression in 114 patients after orthotopic liver transplantation was reviewed, and they concluded that corticosteroids can be safely withdrawn in the majority of patients after OLT.
2 citations