Hypothermic machine perfusion in liver transplantation: a randomized trial

BACKGROUNDTransplantation of livers obtained from donors after circulatory death is associated with an increased risk of nonanastomotic biliary strictures. Hypothermic oxygenated machine perfusion of livers may reduce the incidence of biliary complications, but data from prospective, controlled studies are limited.METHODSIn this multicenter, controlled trial, we randomly assigned patients who were undergoing transplantation of a liver obtained from a donor after circulatory death to receive that liver either after hypothermic oxygenated machine perfusion (machine-perfusion group) or after conventional static cold storage alone (control group). The primary end point was the incidence of nonanastomotic biliary strictures within 6 months after transplantation. Secondary end points included other graft-related and general complications.RESULTSA total of 160 patients were enrolled, of whom 78 received a machine-perfused liver and 78 received a liver after static cold storage only (4 patients did not receive a liver in this trial). Nonanastomotic biliary strictures occurred in 6% of the patients in the machine-perfusion group and in 18% of those in the control group (risk ratio, 0.36; 95% confidence interval [CI], 0.14 to 0.94; P=0.03). Postreperfusion syndrome occurred in 12% of the recipients of a machine-perfused liver and in 27% of those in the control group (risk ratio, 0.43; 95% CI, 0.20 to 0.91). Early allograft dysfunction occurred in 26% of the machine-perfused livers, as compared with 40% of control livers (risk ratio, 0.61; 95% CI, 0.39 to 0.96). The cumulative number of treatments for nonanastomotic biliary strictures was lower by a factor of almost 4 after machine perfusion, as compared with control. The incidence of adverse events was similar in the two groups.CONCLUSIONSHypothermic oxygenated machine perfusion led to a lower risk of nonanastomotic biliary strictures following the transplantation of livers obtained from donors after circulatory death than conventional static cold storage.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Determinación de producción de metano en caprinos alimentados con dietas con distintos cereales

Three primiparous 1.5 year old Murciano-Gra- nadina female goats in maintenance were used. Their average body weight was 33.08 ± 2.1 kg. The objective was to determine methane production in two diets differing of the type of cereal grain (barley or corn). Two consecutive digestibility trials were conducted using diets differing in the cereal type (barley or maize grains). The adaptation period has a duration of 7 days and the digestibility period 5 days. Methane production (CH 4 ) was determined by indirect calorimetry with an open circuit mask adapted to small ruminants. Methane production was determined on day four of digestibility trial, before feeding and three more measurements every 35 minutes during feeding. There were no significant differences neither in dry matter intake (758 g MS/goat and day on average) nor in dry matter digestibility coefficients (CDMS= 69.2% on average). Significant differences (p<0.05) were observed in the methane produc- tion during the feeding time with levels of 0.69 and 0.77 l/h for the barley and maize based diets, respectively. No significant differences between diets were observed when CH 4 was expressed on gross energy intake basis, and the value obtained for the experimental mixed diets was 4.8.Se utilizaron tres cabras primíparas de raza Murciano-Granadina de un año y medio de edad y en estado de mantenimiento, con un peso medio de 33,08 ± 2,1 kg, con el objeto de determinar la producción de metano al administrarles dos dietas que difirieron únicamente en el tipo de cereal (grano de cebada o maíz). Se realizaron dos pruebas de digestibilidad consecutivas mediante la administración de las dos dietas. Tras un perio- do de adaptación de 7 días se analizó la digestibi- lidad aparente durante 5 días. La producción de metano (CH 4 ) se determinó por calorimetría indi- recta mediante una máscara de circuito abierto adaptada a pequeños rumiantes. El CH 4 se midió el día 4 de la prueba de digestibilidad, antes de administrar la ración diaria y se realizaron tres medidas más cada 35 minutos mientras comían. No se observaron diferencias significativas en el consumo de materia seca (con 758 g MS/cabra y día de media), ni entre los coeficientes de diges- tibilidad de materia seca de las dos dietas (CDMS= 69,2% de media). Durante la comida se observa- ron diferencias (p<0,05) en la producción de metano con valores de 0,69 l/h para la dieta que contenía grano de cebada frente a 0,77 l/h para la dieta con grano de maíz. Cuando se expresó la producción de CH 4 sobre la ingestión de energía (Ym) no se observaron diferencias significativas entre dietas, y el valor medio para las dietas mixtas estudiadas fue de 4,8