22. Workshop für experimentelle und klinische Lebertransplantation ...

Transplantationsmedizin
Supplement I – 2011, S. 33
Day of
transplantation
Gel sedimentation
test
PF4/heparin-Ig-G-
ELISA (OD-level)
HIPA (*German
reference center
Greifswald)
-1 Positive Positive (2,089) Positive*
6 Negative Negative Negative*
11 Intermediate Negative (0,141) -
plantation. After hospitalisation and start
of heparin-anticoagulation, she developed
a HIT II. The heparin therapy was stopped
and the anticoagulation was changed into
argatroban, a direct thrombin inhibitor. Despite
the risk of life threatening complications
for acute HIT II patients, the organ
procurement of a heparinized donor was
accepted. To remove the heparin entrapped
in the graft, the organ was prepared backtable
with an additional instillation of Wisconsin
solution. Additionally the direct
thrombin inhibitor argatroban was given to
avoid clotting when antibody-leading
blood from the recipient meets the entrapped
heparin residuals in the graft to
stop the possible heparin-triggered coagulation.
The transplantation was done without any
signs of clotting disorder. The postoperative
course was uneventful and the patient
has been discharged already.
Conclusions:
– Liver transplantation of patients with
newly diagnosed HIT II is not strictly
contraindicated even in case of heparinized
donor.
– Avoidance of heparin in the donor, recovered
organs and in the recipient in
acute and subacute HIT II patients.
– In case of heparinized donor or organ the
transplantation procedure should be performed
after backtable preparation of the
organ with additional flushing with organ
preservation solution, irrigation of
the organ with an alternative anticoagulant
and perioperative anticoagulation
with direct thrombin inhibitors in the recipient.
– The rapid decline of the HIT-antibodies
under the immunosuppression suggests a
treatment option in HIT-II therapy.
Cold Ischemic Tolerance of the
Small Bowel is Increased by
Intestinal Long Chain
Triglyceride Resorption before
Bowel Explant
J. Glatzle, J. Junginger, I. Königsrainer,
R. Ladurner, J. Li, A. Königsrainer,
S. Nadalin
Dept of General, Visceral and Transplant Surgery,
University of Tübingen
The number of small bowel transplants increased
over the last few years. However,
one major problem is the short cold ischemic
tolerance of the small bowel. Previously
we have shown, that intestinal resorption
of long chain triglycerides (LCT)
activates a vago-vagal pathway the so
called “cholinergic anti-inflammatory
pathway”, which controls the activity of
macrophages in the gut wall. Further we
have shown, that resorption of LCT decreases
the inflammatory response of gut
wall macrophages during sepsis.
Hypothesis: Intestinal resorption of LCT
before explant reduces the acticity of gut
wall macrophages and therefore cold ischemic
tolerance of the small bowel might
be prolonged.
Methods: Rats were continuously intestinally
infused either with water (n=6) or
1% LCT solution (n=6, LCT source 80%
olive oil 20% soy bean oil, ClinOleic, Baxter,
Germany, 3ml/h) for 12hrs. Thereafter
rats were anesthetized and systemically infused
with an organ preservation solution
(Histidine-Tryptophan Ketoglutarate,
HTK). The small bowel was then immediately
removed and stored in the HTK solution
on ice. At the time periods t=0, t=60,
t=120, t=180, t=240, t=300, t=360, t=420,
and t=480 a tissue sample of the gut was
fixed and stained with H&E. The tissue
was analyzed by three independent observers
and scored for tissue damage
(0=no damage, 1=minor damage, 2=major
damage, 3= loss of structure) of 1. integrity
of the mucosa, 2. integrity of the basal
membrane of the mucosa and 3. integrity
of villy. The occurrence of the damage was