ADNAN TORGAY, İclal IŞIKLAR, Arash PİRAT, Selim CANDAN, Gülnaz ARSLAN, Mehmet HABERAL

Transplante karaciğerde diltiazem kan akımını etkileyebilir mi? Erken sonuçlarımız

Amaç: Bu prospektif, randomize, kontrollü çalışmanın amacı transplante karaciğer greftlerinin damarlarındaki kan akım hızlarına perioperatif diltiazem infüzyonunun etkisini değerlendirmektir. Yöntem: Canlıdan ortotopik karaciğer transplantasyonu (OKI) yapılmış 17 hasta 2 grup halinde çalışıldı. Bir gruba (Grup D, n=8) postoperatif 24 saat boyunca vasküler anastomoz bittikten hemen sonra başlanarak 1 fig"1 kg'1 dak diltiazem verildi. Aynı dönemde kontrol grubuna (Grup K, n=9) normal şalin infüzy onu yapıldı. Demografik veriler, hemodinamik parametreler, post¬operatif karaciğer fonksiyon testleri ile vasküler anastomoz tamamlandığında ve postoperatif ilk günde hepatik arterdeki, portal vendeki ve hepatik vendeki kan akım parametrelerinin Doppler ultrasonografik ölçümleri kaydedildi. Bulgular: Demografik verilere ve postoperatif karaciğer fonksiyon testlerine bakıldığında gruplar birbirine benzer bulundu. Postoperatif ilk günde grup D hastalarında intraoperatif dönemle karşılaştırıldığında hepatik arterdeki tepe sistolik hız % 28 artmış ve portal ven hızı % 52 azalmıştı. Grup K hastalarında değişim ise arter hızında %1.5, portal ven hızında % 13 artma olarak görüldü. Tek anlamlı değişiklik grup D' deki portal ven akım hızındaki değişiklikti (p

Anahtar Kelimeler:

Karaciğer nakli, Kan akım hızı, Diltiazem, Transplantlar

Can diltiazem affect blood flow in the transplanted liver? A preliminary report

Objective: This prospective, randomized, controlled study evaluated the effects of perioperative diltiazem infusion on blood flow rates in vessels of transplanted liver grafts. Method: Seventeen patients who underwent living-related OLT were studied in two groups. One group (Group D, n=8) re¬ceived diltiazem 1 pig'1 kg'1 min at the end of vascular anastomosis until 24-h postoperatively. The control group (Group, K, n=9) received an infusion of normal saline for this period. Demographic data, hemodynamic parameters, postoperative liver function tests and Doppler ultrasonography measurements of blood flow parameters in the hepatic artery, portal vein, and hepatic vein (at the completion of vascular anastomosis and on postoperative day 1) were recorded. Results: The groups were similar with respect to demographic features and postoperative liver function tests. In Group D, compared with baseline, the findings for peak systolic velocity in the hepatic artery and portal vein on postoperative day 1 revealed increases of 28% and -52%, respectively. The corresponding peak systolic velocity changes in Group C showed an increament of 1.5% and 13%, respectively. The only significant change was the decrease in portal vein flow rate in Group D (p<0.05). Conclusion: This preliminary result suggests that perioperative diltiazem infusion may alter hepatic artery blood flow after OLT. However, the clinical implications of this finding relative to reducing the risk of graft vascular complications after OLT remain to be determined in larger studies.

Keywords:

Liver Transplantation, Blood Flow Velocity, Diltiazem, Transplants,

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1. Bong SK, Tae KK, Dong JJ, ve ark. Vascular complications after living related transplantation: Evaluation with gadolinium-enhanced tree-dimensionel angiography. AJR 2003; 181:467.
2. Pastacaldi S, Teixeira R, Montalto P, Rolles K, Burroughs A. Hepatic artery thrombosis after orthotopic liver transplantation: A review of nonsurgical causes. Liver Transpl 2001; 7: 75.
3. Raby N, Karani J, Thomas S, O'Grady J, Williams R. Stenosis of vascular anastomosis after hepatic transplantation: Treatment with balloon angioplasty. AJR 1991; 157: 167-71.
4. Acar C, Jebara VA, Portoghese M, ve ark. Revival of the radial artery for coronary artery bypass grafting. Ann Thorac Surg 1992; 54:652-9.
5. Sellke FW, Boyle E, Verrier ED. The pathophysiology of vasomotor dysfunction. Ann Thorae Surg 1997; 64: 9-15.
6. Janelle G, Urdaneta F, Martin T, Lobato E. Effetcs of calcium choloride on grafted internal mammary artery flow after cardiopulmonary bypass. J Cardiothorac Vase Anest 2000; 14: 4-8.
7. Arnaudov D, Cohen A, Zabeeda D, ve ark. Effect of systemic vasodilators on internal mammary flow during coronary bypass grafting. Ann Thorac Surg 1996, 62:1816-9.
8. Koski G. Internal mammary artery spasm: Is calcium the culprit? J Cardiothorac Vase Anest 2000; 14:1-3.
9. Zabeeda D, Medalion B, Jackbshvilli S, ve ark. Comparison of systemic vasodilators: effects on flow in internal mammary an radial arteries. Ann Thorac Surg 2001, 71:138-41.
10. Nigbor DA, Lewis JB. Use of calcium antagonists in renal patients: therapeutic benefit or medical malpractice? Curr Hypertens Rep 2003; 5: 430-6.
11. Baroletti SA, Gabardi S, Magee CC, Milford EL. Calcium channel blockers as the treatment of choice for hypertension in renal transplant recipients: fact or fiction. Pharmacotherapy 2003; 23: 788-801.
12. Mehrens T, Thiele S, Suwelack B, Kempkes M, Hohage H. The beneficial effects of calcium channel blockers on long-term kidney transplant survival are independent of blood-pressure reduction. Clin Transplant 2000; 14: 257-61.
13. Jones TE, Morris RG. Pharmacokinetic interaction between tacrolimus and diltiazem: dose-response relationship in kidney and liver transplant recipients. Clin Pharmacokinet 2002; 41: 381-8.
14. Al Edreesi M, Caille G, Dupuis C, Theroet Y, Paradis K. Safety, tolerability, and pharmacokinetic actions of diltiazem in pediatric liver transplant recipients on cyclosporine. Liver Transpl Surg 1995; 1:383.
15. WH Frishman, EH Sonnenblick. Calcium channel blockers. In: Cardiovascular pharmacotherapeutics. WH Frishman (ed), McGraw-Hill Inc, New York, 1996: 101-129.
16. Nagasawa M, Kawasaki T, Yoshimi T. Effects of calcium antagonists on hepatic and systemic hemodynamics in awake portal hypertensive rats. J Gastroenterol 1996; 31:366-72.