Addition of Adenosine to University of Wisconsin Solution: Does It Help?
ABSTRACT Adenosine Triphosphate (ATP) precursors are sometimes added to preservation solutions in the belief that once the organ is reperfused, these precursors will build up ATP rapidly, returning it to its original metabolic state. This work studied ATP and metabolites during preservation of the rat liver using University of Wisconsin solution (UW), which contains adenosine, versus histidine tryptophan ketaglutarate solution a new phosphate-based preservation solution, or leeds solution (LS), which is under development at our institution (neither of the latter 2 contains adenosine). Tissue samples of perfused livers were analyzed for ATP and metabolites by high-performance liquid chromatography. UW did initially show the expected significant difference in overall adenosine levels, but the advantage had disappeared by 4 hours. At no time did UW show significantly higher levels of ATP; this was not seen following adenosine addition to LS. Only in living donor transplants where the cold ischemic time is short may there be some advantage to the addition of adenosine.
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ABSTRACT: PURPOSE: Animal studies have shown the potential benefits of mannitol as renoprotective during warm ischemia; it may have antioxidant and anti-inflammatory properties and is sometimes used during partial nephrectomy (PN) and live donor nephrectomy (LDN). Despite this, a prospective study on mannitol has never been performed. The aim of this study is to document patterns of mannitol use during PN and LDN. MATERIALS AND METHODS: A survey on the use of mannitol during PN and LDN was sent to 92 high surgical volume urological centers. Questions included use of mannitol, indications for use, physician responsible for administration, dosage, timing and other renoprotective measures. RESULTS: Mannitol was used in 78 and 64 % of centers performing PN and LDN, respectively. The indication for use was as antioxidant (21 %), as diuretic (5 %) and as a combination of the two (74 %). For PN, the most common dosages were 12.5 g (30 %) and 25 g (49 %). For LDN, the most common doses were 12.5 g (36.3 %) and 25 g (63.7 %). Overall, 83 % of centers utilized mannitol, and two (percent or centers??) utilized furosemide for renoprotection. CONCLUSIONS: A large majority of high-volume centers performing PN and LDN use mannitol for renoprotection. Since there are no data proving its value nor standardized indication and usage, this survey may provide information for a randomized prospective study.World Journal of Urology 12/2012; DOI:10.1007/s00345-012-1003-1 · 3.42 Impact Factor
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ABSTRACT: The liver plays a vital role in the organism, and thousands of patients suffer and even die from hepatic complications every year. Viral hepatitis is one of the most important causes of liver-related pathological processes. However, sterile liver diseases, such as drug-induced liver injury, cirrhosis and fibrosis, are still a worldwide concern and contribute significantly to liver transplantation statistics. During hepatocyte death, several genuine intracellular contents are released to the interstitium, where they will trigger inflammatory responses that may boost organ injury. Intracellular purines are key molecules to several metabolic pathways and regulate cell bioenergetics. However, seminal studies in early 70s revealed that purines may also participate in cell-to-cell communication, and more recent data have unequivocally demonstrated that the purinergic signalling plays a key role in the recognition of cell functionality by neighbouring cells and also by the immune system. This new body of knowledge has pointed out that several promising therapeutic opportunities may rely on the modulation of purine release and sensing during diseases. Here, we review the most recent data on the physiological roles of purinergic signalling and how its imbalance may contribute to injury progression during sterile liver injury.Liver international: official journal of the International Association for the Study of the Liver 03/2013; 33(3):353-61. DOI:10.1111/liv.12109 · 4.41 Impact Factor
Annals of Plastic Surgery 09/2014; 73(3):341-342. DOI:10.1097/SAP.0000000000000280 · 1.46 Impact Factor