Buccal vs. nasogastric tube administration of tacrolimus after pediatric liver transplantation

Tacrolimus is an important drug for immunosuppression after liver transplantation. Bioavailability of enterally administered tacrolimus is poor, and further reduced by gastric residuals or by enteral nutrition. Buccal administration might be an alternative route especially in children. Tacrolimus trough levels (TTLs) obtained after buccal administration of tacrolimus after liver transplantation have not been reported. The aim of this study was to determine whether buccal administration of tacrolimus is feasible and to compare TTLs after nasogastric tube (NGT) administration with buccal administration. TTLs after NGT or buccal administration during the first week after pediatric liver transplantation were analyzed from 28 cadaveric liver transplants in 23 pediatric recipients between June 2002 and March 2004. Each level was scored within, under or above the target range. Buccal administration was well tolerated in all patients. A total of 149 TTLs were obtained of which nine were excluded because of incomplete information on target levels. Overall 27% of TTLs was adequate. The percentage of levels under, within and above the target range were comparable in both groups (chi-square test; p = 0.64). Both groups had a decrease in percentages within the target range on day 3 and 4 after liver transplantation with a subsequent rise. Buccal tacrolimus administration is feasible. Similar TTLs are achieved compared with NGT tacrolimus administration during the first week after pediatric liver transplantation

THE INFLUENCE OF AN IMPROVED PRESERVATION SOLUTION ON PROGNOSTIC FACTORS FOR GRAFT-SURVIVAL IN PEDIATRIC LIVER-TRANSPLANTATION

We investigated the influence of Eurocollins (EC) and University of Wisconson solution (UW) on prognostic factors for graft survival after pediatric liver transplantation. The 1-year graft survival was studied for 30 patients in which 38 transplantations were performed between 1982 and 1988. We preserved 19 grafts in EC and the other 19 grafts in UW solution. For grafts preserved in EC, the median preservation time was 5 h compared to 10.8 h for grafts preserved in UW solution (P <0.01). Graft survival at 1 year was equivalent in both groups (63 %). No significant differences were observed between the two groups for the following variables: patient diagnosis, child-pugh score, age, operative time, anhepatic phase, blood loss, morbidity, ICU stay, donor age and graft survival. Multivariate analysis indicated that in the EC group anhepatic phase, blood loss and preservation time were significant predictors of graft survival whereas in the UW group, none of these factors appeared to be significant. We concluded that UW was superior to EC solution in pediatric liver transplantations because it allowed longer preservation times, the length of the anhepatic phase was less important and the tolerance for blood loss seemed to be extended

INFERIOR VENA-CAVA OBSTRUCTION AFTER ORTHOTOPIC LIVER-TRANSPLANTATION

Post-operative inferior vena cava (IVC) obstruction is reported as an uncommon complication after orthotopic liver transplantation (OLT). We report 6 cases after 245 OLT's in the period between March '79 and December '92. Compression or torsion of the IVC or a technical problem were underlying causes. Oligo-anuria was observed in almost all patients and was probably caused by renal vein hypertension. Doppler ultrasound has become an important tool for the diagnosis of this complication. Operative treatment was performed in almost all cases in order to correct causative factors. Thrombi above or at the level of the upper anastomosis of the IVC should be removed via the right atrium, during cardio-pulmonary bypass, in order to prevent pulmonary embolism. Thrombi in the IVC caudal to the liver can be removed by cavotomy with high positive end expiratory pressure ventilation