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25 May 2009

Clearing off wisconsin solution used in liver transplantation in pediatric patients

Ahmet Mahli, Demet Coskun, Gizem Ilvan, Sema Oncul, Hakan Sozen, Aydin Dalgic

Am J Case Rep 2009; 10:72-74 :: ID: 869656

Abstract

Background: Organ preservation is an important component of transplantation process. It ensures the vitability of the donor’s organ until the time of its implantation in the receiver.
Case Report: A 7.5-month-old, 7300 gram female infant who had been diagnosed with neonatal cholestatic hepatitis at the age of one month and who had never undergone surgery before was operated on for liver transplantation. The left lobe of the liver donated by the mother was applied 500 ml of Wisconsin solution for preservation. At the end of anhepatic phase, K+ value of the receiver was 4.5 meq/L. Before the neohepatic phase, a cleansing solution of 100 ml of 20% human albumin in 1000 ml of 5% dextrose was prepared to clean the donor’s liver off University of Wisconsin (UW) solution and K+ in particular. Until the fluid drained from the donor’s liver was clear, the donor’s liver was administered 300 ml of the solution. As the washing was considered to be inadequate, this process was sustained by using 800 ml of the washing solution. The first K+ value measured after reperfusion was 5.5 meq/L. The operation was completed without any complications and no problems were encountered during the postoperative 6-month follow-up.
Conclusions: No information was found in literature regarding how much washing solution should be used to reduce the K+ burden that occurs in the receiver as a result of K+ rich UW solution which is used in order to protect the organ during liver transplantation. Organ washing procedure is conventionally extended until the washing solution becomes clear. However, in pediatric cases, we propose that the washing procedure has to be extended not until the washing solution becomes clear but until 100 ml of human albumin 20% in 1000 ml of 5% dextrose solution is used up.

Keywords: University of Wisconson (UW) solution, pediatry, liver transplantation (LTX)

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923