Assessment and modulation of complications following liver transplantation

Devlin, John (1995) Assessment and modulation of complications following liver transplantation. MD thesis, University of Glasgow.

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Abstract

The clinico-pathogical characteristics, diagnostic protocols and management of events which cause graft or systemic complications following liver transplantation are inadequately defined. In this thesis, the principal categories of such post-transplant complications were determined from a systematic examination of 127 consecutive failed liver transplants and classified. Several clinical and experimental protocols for assessment and management of the defined major clinico-pathological categories were then examined. Primary graft dysfunction, secondary to impaired donor organ viability, was an important but not easily predictable determinant of early post-transplant outcome. Measurement of liver cell enzyme activities in the preservation solution, washed-out at the end of graft storage, was found to be valuable in prediction of early graft function. Recipients with the highest AST enzyme activity in this fluid experienced the most impaired biochemical graft dysfunction. More significantly, rejection frequency was higher and one month graft survival lower in this group compared to patients with low levels. Markers of liver endothelial cell (CK-BB, PNP) damage did not correlate with early graft viability. Vascular complications were also a common cause of severe graft dysfunction and failure. The value of hepatic angiography in defining the extent and pattern of arterial lesions and their significance in graft survival was examined. Intrahepatic attenuation of the arterial tree in early graft dysfunction was associated with an unfavourable outcome. Similarly, during chronic rejection the presence of arteriopathy, even if absent on histological assessment, was accompanied by a poor prognosis. Angiography was also found to be more sensitive than doppler ultrasonography in assessing hepatic arterial thrombosis or stenosis and is recommended as the preferred investigation. Vascular compromise and systemic haemodynamic derangements are present in primary graft dysfunction. N-acetylcysteine was shown to improve systemic oxygen delivery, consumption and ICG extraction in post-transplant patients. These properties should be clinically useful in critical illnesses (especially following transplantation) where the systemic and hepatic-splanchnic circulation is compromised. Allograft rejection was found to be the single largest pathological process leading to transplant failure. Characterisation of clinical risk factors for rejection may provide insight into underlying mechanisms and development of therapeutic strategies. (Abstract shortened by ProQuest.).

Item Type: Thesis (MD)
Qualification Level: Doctoral
Additional Information: Adviser: Roger Wiliams
Keywords: Medicine, Immunology
Date of Award: 1995
Depositing User: Enlighten Team
Unique ID: glathesis:1995-71666
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 17 May 2019 09:31
Last Modified: 17 May 2019 09:31
URI: http://theses.gla.ac.uk/id/eprint/71666

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