2010 - TTS International Congress
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Pediatrics
65.44 - Analysis of metabolic changes at reperfusion in children undergoing intestinal transplantation
Presenter: CRISTINA, DOPAZO-TABOADA, BIRMINGHAM,
Authors: DOPAZO-TABOADA C., TAHA A., GUPTE G., SHARIF K., HARTLEY J., MUIESAN P., MAYER D., BROMLEY P., BENET J., MIRZA D.
PEDIATRICS
C. Dopazo-taboada1, A. Taha2, G. Gupte2, K. Sharif2, J. Hartley2, P. Muiesan3, D. Mayer3, P. Bromley4, J. Benet4, D. Mirza2
1Liver Unit, BIRMINGHAM CHILDREN´S HOSPITAL, BIRMINGHAM/UNITED KINGDOM, 2Liver Unit, BIRMINGHAM CHILDREN'S HOSPITAL, BIRMINGHAM/UNITED KINGDOM, 3Liver Unit, QUEEN ELIZABETH HOSPITAL, BIRMINGHAM/UNITED KINGDOM, 4Anesthesiology, BIRMINGHAM CHILDREN'S HOSPITAL, BIRMINGHAM/UNITED KINGDOM
Body:
AIM.To analyse recipient metabolic disorders during reperfusion of intestinal grafts for an optimal patient management during small bowel transplantation. MATERIAL AND METHODS. From December 1999 to August 2009, 51 primary small bowel transplants were performed in our Unit. Thirty nine patients underwent liver and small bowel transplant (LB) and 12 underwent isolated small bowel transplant (SB). We compared the metabolic changes pre- and post-reperfusion between LB and SB group and we analysed the impact of significant acidosis 30 min post-reperfusion (BE<-13) in transplant outcome. The data collected included pH, PaCO2, HCO3 and BE at defined intervals: baseline (T0), pre-reperfusion (T1), 30min post-reperfusion (T2) and 120min post-reperfusion (T3). RESULTS. The metabolic analysis is recorded in Table 1. We observed significant differences between mean BE measured at T1 in SB vs LB (-4.7±5.9 vs -9.3±4.9, p0.01) and mean BE measured at T2 in SB vs LB (-6.8±2.4 vs -13.1±4, p0.001). The group of patients with severe metabolic acidosis 30min post-reperfusion (BE<-13) presented statistical differences in organs transplanted including liver (p 0.01), pre-transplant low platelets (p0.005), peri-operative platelet transfusion (p.0001) and warm ischemia time >45min (p0.03). Despite that we did not find any significant difference between ICU stay, re-laparotomy, compartmental syndrome or vascular complications in this group of patients, severe metabolic acidosis 30min post-reperfusion was a predictive factor for early mortality (p 0.04). CONCLUSION. Significant metabolic changes occur in liver and small bowel transplant and reflect more ischemia/preservation and reperfusion injuries in this group of patients. Further studies are needed to evaluate whether these metabolic changes may be predictive of adverse graft outcome.
| SB | LB | p | |
| T0 | |||
| pH pCO2 (mmHg) HCO3 (mmol/L) BE (mmol/L) | 7.3±0.6 6.1±1.3 24±2.2 0.3±3 | 7.3±0.9 5.9±1.1 22±4 -3.2±5 | ns ns ns ns |
| T1 | |||
| pH pCO2 (mmHg) HCO3 (mmol/L) BE (mmol/L) | 7.3±0.05 5.3±0.6 21.4±2.3 -4.7±5.9 | 7.2±0.1 4.4±1.2 18.1±3.9 -9.3±4.9 | ns 0.039 0.06 0.019 |
| T2 | |||
| pH pCO2 (mmHg) HCO3 (mmol/L) BE (mmol/L) | 7.2±0.8 5.6±1.0 19.3±2.5 -6.8±2.4 | 7.1±0.1 5.3±0.9 15.5±3.7 -13.1±4 | 0.037 ns 0.012 0.001 |
| T3 | |||
| pH pCO2 (mmHg) HCO3 (mmol/L) BE (mmol/L) | 7.2±0.05 5.3±0.79 18±1.8 -8.2±2 | 7.2±0.16 7.4±9.55 19±5 -8.4±5.7 | ns ns ns ns |
Table 1. Mean values±standard desviation of metabolic variablesrecorded during small bowel transplant
Disclosure: All authors have declared no conflicts of interest.
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