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The influence of warm ischemia on calcium mobilization in liver transplantation was investigated. Twenty-four porcine orthotopic liver transplantations were performed by a temporary portal arterialization technique. Swine were divided into three groups according to warm ischemia time; I (0 min, n=9), II (30 min, n=8), and III (60min, n=7). Ionized calcium was measured in arterial and hepatic venous blood, in initial perfusate, and in initial perfused blood. In group I, all the pigs survived, while in group III all succumbed. In group II, four survived and four died. Ionized calcium level in influx showed no differences, but the level in the initial perfusate in group I was significantly higher than that in group III. The level in the initial perfused blood in group I was significantly higher than levels in groups II and III. Retrospective analysis in group II showed that ionized calcium value in the initial perfused blood in the survivors was significantly higher than that in the non-survivors. A substantial amount of ionized calcium accumulated after revascularization in the graft loaded with warm ischemia, and, in group II, significantly more ionized calcium accumulated in the non-survivors. [ABSTRACT FROM AUTHOR]

A 2 1/2-year-old boy with biliary atresia underwent orthotopic living-related liver transplantation. On the 7th postoperative day, he had an episode of hepatic arterial thrombosis following disseminated intravascular coagulation (DIC) due to severe intraabdominal sepsis. Tissue plasminogen activator was administered regionally and the hepatic arterial flow recovered promptly. On postoperative day 33, portal vein thrombosis occurred and direct tissue plasminogen activator injections into the portal vein improved portal blood flow. However, the patient eventually died of poorly controlled DIC. Throughout the course, color Doppler ultrasonogram and arterial ketone body ratio were good indicators of hepatic arterial and portal blood flow. When hepatic arterial thrombosis and portal vein thrombosis occur, retransplantation is often inevitable. Thus, while the patient is awaiting a suitable donor, it could be possible to maintain blood flow to the graft with this new thrombolytic therapy. [ABSTRACT FROM AUTHOR]