Patients undergoing orthotopic liver transplantation may develop significant haemodynamic instability, especially during anhepatic phase and immediately after reperfusion of the graft. The haemodynamic instability may be caused directly by myocardial depression due to pathogenic substances released from the liver, or by acute blood loss.^1 Creatine kinase（CK） and its MB fraction （CK-MB） are sensitive and specific indicators to reflect myocardial damage.^2 Cardiac troponin I （cTnl） is a specific and sensitive marker of myocardial necrosis.^3 This study assessed perioperative cardiac function using three indicators （CK,CK-MB,and CTnl） to evaluate perioperative myocardial damage.
HEI Zi-qing LIU De-zhao LUO Chen-fang LI Shang-rong MA Wu-hua LUO Gang-jian
Background Acute renal failure （ARF） after liver transplantation is associated with high mortality and morbidity. Early therapeutic or preventive intervention is hampered by the lack of early effective prognostic factors. Recent studies indicated that serum levels of cystatin C and β2-microglobulin （β2 MG） as well as urinary β2 MG and N-acetyI-β-D- glucosaminidase （NAG） would increase in patients with early and mild renal impairment. In this study, these factors were detected during the different stages in patients who accepted orthotopic liver transplantation （OLT）, and their feasibilities to predict early ARF after OLT were also analyzed. Methods Sixty patients with normal blood urea nitrogen （BUN） and serum creatinine （SCr） who received modified piggyback liver transplantation without veno-venous bypass were prospectively studied. Blood samples were drawn from patients for the determination of serum β2 MG（n=60）, SCr （n=60） and serum Cystatin C （n=39） at following 5 intervals： before operation （TO）, 20 minutes before anhepatic phase （T1）, 25 minutes in anhepatic （T2）, 60 minutes after reperfusion （T3） and at the end of operation（T4）. Urinary B2 MG （n=60） and NAG （n=60） were also examined at following 3 intervals： before operation （TO）, 60 minutes after reperfusion （T3） and at the end of operation （T4）. According to the Rimola A criteria of ARF in 24 hours after operation, all the patients were divided into two groups： ARF group and non-ARF group. The data were statistically analyzed to evaluate the feasibiliy of regarding these factors as prognostic factors for early ARF after liver transplantation in patients with normal SCr and BUN before operation. Results Ten of sixty cases showed ARF（16.7%）. The Logistic regression analysis showed that the levels of serum and urinary β2 MG as well as serum cystatin C before operation were correlated with early ARF after liver transplantation （P 〈0.05）, while only serum levels
HEI Zi-qing LI Xiao-yun SHEN Ning PANG Hong-yu ZHOU Shao-li GUAN Jian-qiang
