Reoperative Complications after Primary Orthotopic Liver Transplantation: A Contemporary Single-Center Experience in the Post–Model for End-Stage Liver Disease Era

BackgroundData on complications requiring reoperation after orthotopic liver transplantation (OLT) are limited. We sought to describe the spectrum of reoperative complications after OLT, evaluate the associations with graft and patient survival, and identify predictors of need for reoperation.Study designWe retrospectively studied adult patients who underwent primary OLT at our institution from February 2002 to July 2012. The primary outcomes included occurrence of a reoperative complication. Secondary outcomes were graft and patient survival. Multivariable logistic regression analysis was used to model the associations of recipient, donor, and operative variables with reoperation.ResultsOf 1,620 patients, 470 (29%) had complications requiring reoperation. The most common reoperative complication was bleeding (17.3%). Compared with patients not requiring reoperation, patients with reoperative complications had greater Model for End-Stage Liver Disease scores and need for pretransplantation hospitalization, mechanical ventilation, vasopressors, and renal replacement therapy; considerably longer cold and warm ischemia times and greater intraoperative blood transfusion requirements; and substantially worse 1-, 3-, and 5-year graft and patient survival rates. In multivariable analysis, predictors of reoperative complications included intraoperative transfusion of packed RBCs (odds ratio [OR] = 2.21; 95% CI, 1.91-2.56), donor length of hospitalization >8 days (OR = 1.87; 95% CI, 1.28-2.73), recipient pretransplantation mechanical ventilation (OR = 1.65; 95% CI, 1.21-2.24), cold ischemia time >9 hours (OR = 1.63; 95% CI, 1.23-2.17), warm ischemia time >55 minutes (OR = 1.58; 95% CI, 1.02-2.44), earlier major abdominal surgery (OR = 1.41; 95% CI, 1.03-1.92), and elevated donor serum sodium (OR = 1.17; 95% CI, 1.03-1.31).ConclusionsPatients who require reoperation for complications after OLT have high pretransplantation acuity and inferior post-transplantation survival. We identified factors associated with reoperative complications to guide perioperative donor-recipient matching and improve outcomes

Utilization of a hydraulic barrier to control migration of a uranium plume

A uranium plume emanating from the U.S. Department of Energy`s Fernald Environmental Management Project (FEMP) in Fernald, Ohio had migrated off site and the leading edge of the plume had already mixed with an organic and inorganic plume emanating from two industries south of the FEMP. A method was needed to prevent the further southern migration of the plume, minimize any impacts to the geometry, concentrations, distribution or flow patterns of the organic and inorganic plumes emanating from the off-site industries, while meeting the ultimate cleanup goals for the FEMP. This paper discusses the use of a hydraulic barrier created to meet these goals by pumping a five well recovery system and the problems associated with the disposition of over 2 million gallons per day of water with low concentrations of uranium

Preservation of Canine Platelets with Iloprost (ZK 36374) during Extracorporeal Circulation

(J. Extra-Corpor. Technol. 19[3] p. 258-264 Fall 1987, 23 ref.) Contact between blood and synthetic/air interfaces during extracorporeal circulation (ECC) results in adverse platelet alterations. We tested the efficacy of a new reversible potent prostacyclin analogue, iloprost (ZK 36374), in preventing these untoward conseguences in fifteen mongrel dogs undergoing extracorporeal circulation using either a membrane or bubble oxygenator. In treated groups, infusion of iloprost was incrementally increased to 150 ng/kg/min at least 15 minutes prior to incision. Equal infusion volumes of saline were administered to the control group. Platelet counts in control dogs (n = 6, membrane/control) decreased to 57 ± 10% (mean ± standard error of the mean) of initial levels by 30 minutes of ECC; in contrast, dogs infused with iloprost demonstrated consistently stable platelet counts despite perfusion with either membrane (1 07 ± 1 0%, n = 6) or bubble (81 ± 13%, n = 3) oxygenators. At 30 minutes of ECC, the iloprost infusion was discontinued. Although the platelet counts in the membrane iloprost-treated group continued to remain stable (99 ± 7%), platelet counts in the bubble iloprost-treated group droppped precipitously to 49 ± 1 0% within 60 minutesof discontinuance of infusion. Furthermore, by 90 minutes of ECC, platelets continued to demonstrate reduced sensitivity to ADP as measured by percent light transmission in both control (53 ± 15%) and bubble iloprost-treated (20 ± 16%) groups. In contrast, the membrane iloprost-treated group regained normal reactivity (80 ± 15%). We conclude that iloprost effectively prevents adverse platelet alterations during ECC. Furthermore, its salutary effects in membrane oxygenator systems persist long after platelet functional inhibition is reversed