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Background and aims: Hemodynamic instability during postreperfusion syndrome remains the most significant concern for transplantation teams. Various strategies have been investigated in an attempt to reduce the occurrence of postreperfusion in liver transplantation, including the use of mannitol as a scavenger of free radicals and inflammatory mediators. The study examined mannitol intraoperative antioxidant effect on reperfusion hemodynamic events during living donor liver transplantation (LDLT). Methodology: This prospective randomized controlled trial divided 60 participants with endstage liver disease into two groups of 30 participants each. The mannitol group was administered 1 g/kg of mannitol (20%) in a 500-mL labeled bottle (solution A); the control group received the same amount of normal saline (0.9%) in a 500-mL labeled bottle (solution B). The primary outcome was mean arterial pressure (MAP) postreperfusion. Secondary outcomes were recorded after reperfusion: cardiac output (COP), systemic vascular resistance (SVR), the amount of vasopressor administered, central venous pressure (CVP), and urine output (UOP). This study received ethics committee approval (R 42/2022) and was registered at clinicaltrials. gov (NCT05277623). Results: The MAP parameters were significantly lower in the control group, with MAP<60 mm Hg in 93.3% of the control group versus 40% of the mannitol group (p 0.001). There was a statistically significant difference regarding SVR (p 0.001). Norepinephrine levels were lower for the mannitol group compared with controls (p = 0.003). As regards COP, CVP, and UOP there was no statistically significant difference between the two groups. Conclusion: Mannitol attenuates the postreperfusion syndrome during LDLT. [ABSTRACT FROM AUTHOR]

Byline: Mona. Ammar, Amr. Abdou Background and Aims: The proportion of patients undergoing living donor liver transplantation is high especially in countries without or with limited cadaver organ sharing programs. [...]

Background: Nutrition is an integral part of health maintenance. The liver is the largest and most important metabolic organ, playing a pivotal role in integrating several biochemical pathways of carbohydrate, fat, protein, and vitamin metabolism. Malnutrition is a common complication of end- stage liver disease (ESLD). Progressive deterioration of nutritional status has been associated with poor outcome in cirrhotic patients. Liver transplantation (LT) revolutionized the management of liver disease. Nutritional therapy is an integral part of liver transplant care. Objective: To identity the efficacy of different dietary nutritional supplements as zinc, vit D and immunonutrients (glutamine, omega 3, arginine and ribonucleic acid) for recipient at early post operative course. Material and Methods: In this systematic review and meta-analysis we enrolled a total of 7 studies for assessing the clinical outcomes of ICU patients underwent liver transplantation surgery and supplied with dietary supplements during early postoperative period. The studies also assessed the laboratory assessment of patients postoperatively during ICU admission period. Results: Regarding postoperative dietary supplementations with HMB, we found significant difference for appendicular skeletal muscle mass (ASMI) regarding the baseline and the postoperative ASMI in the intervention group with HMB. But we did not report significant difference regarding the baseline and the postoperative Fat-free mass index (FFMI) in both intervention and control group with HMB. Also we did not find significant difference between base line and postoperative in both groups for Mid-arm muscle-circumference (MAMC), Fat mass index (FMI), 6-minute walk test (6MWT), and Handgrip (HG). Data Sources: Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021. Conclusion: BCAA as dietary supplementation showing a significant favorable effect regarding the baseline and the postoperative BTR levels, also for BCAA levels, Tyrosine levels, prealbumin levels, retinol binding protein and PTINR levels in both intervention and control groups. For HMB, we found significant difference for appendicular skeletal muscle mass (ASMI) regarding the baseline and the postoperative ASMI in the intervention group with HMB. But we did not report significant difference regarding the baseline and the postoperative Fat-free mass index (FFMI) in both intervention and control group with HMB. [ABSTRACT FROM AUTHOR]

Background The concept of brain death is still not acceptable nor implemented in Egypt. Donor safety in liver transplantation is on the top of our priorities. Purpose The purpose of this study is to evaluate the effectiveness of using IJV distensibility as a reliable method for intraoperative assessment of fluid responsiveness. Methods A prospective observational study was conducted in Ain Shams university specialized hospitals. 40 donor candidates for right lobe hepatectomy for living donor liver transplantation were enrolled. During period of hypovolemia (T0) left IJV scanned and measured. After a given fluid bolus in the form of ringer acetate 5 ml/kg. ultrasonic and hemodynamic measurements were reassessed 10 min (T 10) after the fluid resuscitation. Results Highly significant changes in MABP, HR, and CVP (p < 0.01) were detected after fluid resuscitation, regarding the IJV distensibility it showed a highly significant reduction from baseline (T0) to post-resuscitation expansion (P = 0.0001). Baseline (T0) measurements showed no significant correlation between IJV distensibility and hemodynamic parameters (P ≥ 0.05). Post-resuscitation values (T10) showed no significance correlation between HR and IJV distensibility (P = 0.772). On the other side it showed a highly significance negative correlation between MABP, CVP and IJV distensibility (r = −0.390, P = 0.013) and (r = −0.332 ∗ , p = 0.036) respectively. The correlation between the percentages of change of IJV distensibility and hemodynamic parameters showed highly significant negative correlation between IJV distensibility and MABP (r = −0.359, P = 0.023) also with CVP (r = −0.464, P = 0.017). No difference was found regarding the HR (P = 0.336). Conclusion Organ transplantation centers with experience, CVP monitoring may not be necessary in highly selective patient population. IJV distensibility, a non-invasive and safe method can be used to guide fluid replacement in healthy donor. [ABSTRACT FROM AUTHOR]