Background/Objectives: In the present study, we hypothesized that cardiac surgery in pediatric patients with congenital heart disease (CHD) leads to profound endothelial glycocalyx degradation, measured as the increase in plasma syndecan-1 concentration, and that this endothelial damage is more pronounced in patients with cyanotic CHD. Methods: A total of 40 infants (24 with acyanotic and 16 with cyanotic CHD) were enrolled in this prospective study. A total of 39 cardiac surgeries were performed with cardiopulmonary bypass (CPB), 38 with CPB and aortic clamping, and 3 with CPB, aortic clamping, and deep hypothermic circulatory arrest. Results: Syndecan-1 concentrations increased significantly post-surgery compared to the baseline in both groups (cyanotic: 24.4 to 48.0 ng/mL, p < 0.0001; acyanotic: 28.8 to 59.8 ng/mL, p < 0.0001). However, there was no significant difference in syndecan-1 concentrations at any timepoint between children with cyanotic and those with acyanotic CHD. Baseline syndecan-1 showed no correlation with preoperative arterial oxygen saturation (r = 0.26, p = 0.102), hemoglobin (r = -0.3, p = 0.06), age (r = 0.15, p = 0.36), and weight (r = 0.13, p = 0.42). Of note, CPB time (r = 0.08, p = 0.63) and AC time (r = 0.03, p = 0.86) were not related to syndecan-1 concentrations at the end of surgery. Conclusions: Cardiac surgery leads to profound glycocalyx degradation in children with CHD detected by increased plasma syndecan-1 concentrations. Regardless of major pathophysiological differences, children with cyanotic and acyanotic CHD presented similar plasma syndecan-1 values throughout the study.

Obwohl der Anteil von Ärztinnen steigt, bestehen in der Anästhesiologie weiterhin geschlechtsbezogene Disparitäten, insbesondere in Führungspositionen. Bibliometrische Analysen der Anästhesie und Intensivmedizin zeigen einen moderaten Anstieg weiblicher Autorinnen über die letzten Jahrzehnte, zuletzt jedoch eine Stagnation dieser Entwicklung und damit eine persistierende Unterrepräsentation von Frauen, insbesondere bei Letztautor:innenschaften. Der Artikel fasst den Status quo zusammen, benennt zentrale Ursachen und diskutiert evidenzbasierte Maßnahmen zur Förderung von Geschlechtergerechtigkeit und Diversität in der Anästhesiologie.

Background: Acute kidney injury (AKI) is common after orthotopic liver transplantation (OLT). In major surgery, anemia has been associated with postoperative AKI. Although patients undergoing OLT frequently suffer from anemia, its impact on postoperative AKI remains unclear. We performed a single-center retrospective study including 724 patients undergoing their first OLT between January 2004 and December 2019 at the Medical University of Vienna. We evaluated whether perioperative hemoglobin concentrations were associated with postoperative AKI, renal replacement therapy, or mortality. Preoperative hemoglobin concentrations were 10.9 ( ± 2.1) g/dL in patients with AKI after OLT and 11.5 ( ± 2.1) g/dL in those without. Higher preoperative hemoglobin concentrations were associated with a lower probability of AKI (OR 0.847; P < 0.001) and a decreased probability of developing a higher AKI stage (OR: 0.895; P = 0.002). Stage 3 AKI was associated with increased 1-year (OR: 1.909; P < 0.001) and overall mortality (HR: 1.420; P = 0.037). Higher nadir hemoglobin concentrations within 48 h after OLT were associated with a lower probability of AKI (OR: 0.806; P = 0.033) and a decreased probability of developing a higher AKI stage (OR: 0.782; P < 0.001). In conclusion, higher perioperative hemoglobin concentrations were associated with a lower probability of AKI after OLT. Severe AKI was associated with an increased mortality.

Perioperative hypoalbuminemia has been associated with worse outcome after major surgery. Although hypoalbuminemia is common in patients with chronic liver disease and frequently occurs following liver transplantation (LT), data are sparse regarding perioperative hypoalbuminemia and outcome after LT. In this single-center retrospective study performed at the Medical University of Vienna, we evaluated adult patients undergoing orthotopic liver transplantation (OLT) between 2004 and 2019. The association between perioperative serum albumin concentrations and survival, acute kidney injury (AKI), and postoperative surgical complications was analyzed using cox and logistic regression models. In total, 724 patients were analyzed. Serum albumin concentrations decreased from 32.0 ± 6.8 to 22.8 ± 4.8 g/l (nadir within 48 h following OLT). Overall survival was not associated with serum albumin concentrations on day 1, day 2, or at nadir within 48 h after OLT (Day1: HR:0.988, 95

Background: In light of the opioid epidemic, opioid-prescribing modalities for postoperative pain management have been discussed controversially and show a wide variation across geographic regions. The aim of this study was to compare postoperative pain treatment regimes. Methods: We performed a matched cohort study of women undergoing hysterectomy in Austria (n = 200) and Canada (n = 200). We aimed to compare perioperative opioid medications, converted to morphine equivalent dose (MED) and doses of non-opioid analgesic (NOA) within the first 24 h after hysterectomy, and opioid prescriptions at discharge between the two cohorts. Results: The total MED received intraoperatively, in the post-anaesthesia care unit (PACU) and during the first 24 h after surgery, was similar in both cohorts (145.59 vs. 137.87; p = 0.17). Women in the Austrian cohort received a higher MED intraoperatively compared to the Canadian cohort (117.24 vs. 79.62; p < 0.001) but a lower MED in the PACU (25.96 vs. 30.42; p = 0.04). The primary outcome, MED within 24 h in the postoperative ward, was markedly lower in the Austrian compared to the Canadian cohort (2.36 vs. 27.98; p < 0.001). In a regression analysis, only the variables “Country” and “mode of hysterectomy” affected this outcome. A total of 98.5% in the Canadian cohort were given an opioid prescription at discharge vs. 0% in the Austrian cohort. Conclusions: Our analysis reveals marked differences between Austria and Canada regarding pain management practices following elective hysterectomy; the significantly higher intraoperative and significantly lower postoperative MED administration in the Austrian cohort compared to the Canadian cohort seems to be significantly affected by each country’s cultural attitudes towards pain management; this may have significant public health consequences and warrants further research.

Background:Ischemia reperfusion injury (IRI) is a major contributing factor to organ damage in liver transplantation (LT) impacting donor organ quality and patient survival. IRI-inflicted graft injury can be reduced by using hypothermic oxygenated machine perfusion (HOPE) as a preservation strategy instead of static cold storage (SCS). The endothelial glycocalyx is highly sensitive to IRI and its degradation during graft preservation and reperfusion was previously associated with inferior postoperative outcome after LT. Here, we aimed to measure glycocalyx degradation during and after HOPE in order to evaluate its potential for viability-assessment during machine perfusion and outcome prediction in patients undergoing LT. Methods:Glycocalyx degradation was quantified via enzyme-linked immunoassay (ELISA) for its main component syndecan-1 (Sdc-1) in serum of 40 patients undergoing LT after HOPE. In addition, Sdc-1 was evaluated at multiple time points during HOPE. Patients were followed up for 3.5 years to assess postoperative complications including morbidity, the development of early allograft dysfunction (EAD) and graft survival. Results:Liver grafts which later developed EAD showed significantly higher Sdc-1 concentrations after 60 min of HOPE compared to grafts exhibiting normal postoperative function (P=0.02). Receiver operating characteristic analysis revealed a strong predictive potential with an area under the curve of 0.73. A cut-off at 808 ng/mL Sdc-1 at 60 min of HOPE allowed identification of a high-risk group with an incidence of EAD of 66.7%. Sdc-1 concentrations increased during all types of HOPE but were significantly higher in HOPE versus dual HOPE (D-HOPE) after 120 min of perfusion (P=0.02). Conclusions:Sdc-1 evaluated at 60 min during HOPE allows prediction of EAD after LT. Accordingly, Sdc-1 should be considered a potential additional biomarker for viability assessment during HOPE.

BackgroundProlonged critical illness is often accompanied by an impairment of adrenal function, which has been frequently related to conditions complicating patient management. The presumed connection between hypoxia and the pathogenesis of this critical- illness- related corticosteroid insufficiency (CIRCI) might play an important role in patients with severe acute respiratory distress syndrome (ARDS). Since extracorporeal membrane oxygenation (ECMO) is frequently used in ARDS, but data on CIRCI during this condition are scarce, this study reports the behaviour of adrenal function parameters during oxygenation support with veno-venous (vv)ECMO in coronavirus disease 2019 (COVID-19) ARDS.MethodsA total of 11 patients undergoing vvECMO due to COVID-19 ARDS at the Medical University of Vienna, who received no concurrent corticosteroid therapy, were retrospectively included in this study. We analysed the concentrations of cortisol, aldosterone, and angiotensin (Ang) metabolites (Ang I–IV, Ang 1–7, and Ang 1–5) in serum via liquid chromatography/tandem mass spectrometry before, after 1 day, 1 week, and 2 weeks during vvECMO support and conducted correlation analyses between cortisol and parameters of disease severity.ResultsCortisol concentrations appeared to be lowest after initiation of ECMO and progressively increased throughout the study period. Higher concentrations were related to disease severity and correlated markedly with interleukin-6, procalcitonin, pH, base excess, and albumin during the first day of ECMO. Fair correlations during the first day could be observed with calcium, duration of critical illness, and ECMO gas flow. Angiotensin metabolite concentrations were available in a subset of patients and indicated a more homogenous aldosterone response to plasma renin activity after 1 week of ECMO support.ConclusionOxygenation support through vvECMO may lead to a partial recovery of adrenal function over time. In homogenous patient collectives, this novel approach might help to further determine the importance of adrenal stress response in ECMO and the influence of oxygenation support on CIRCI.

Background: Ischemia reperfusion injury (IRI) is a major contributing factor to organ damage in liver transplantation (LT) impacting donor organ quality and patient survival. IRI-inflicted graft injury can be reduced by using hypothermic oxygenated machine perfusion (HOPE) as a preservation strategy instead of static cold storage (SCS). The endothelial glycocalyx is highly sensitive to IRI and its degradation during graft preservation and reperfusion was previously associated with inferior postoperative outcome after LT. Here, we aimed to measure glycocalyx degradation during and after HOPE in order to evaluate its potential for viability-assessment during machine perfusion and outcome prediction in patients undergoing LT. Methods: Glycocalyx degradation was quantified via enzyme-linked immunoassay (ELISA) for its main component syndecan-1 (Sdc-1) in serum of 40 patients undergoing LT after HOPE. In addition, Sdc-1 was evaluated at multiple time points during HOPE. Patients were followed up for 3.5 years to assess postoperative complications including morbidity, the development of early allograft dysfunction (EAD) and graft survival. Results: Liver grafts which later developed EAD showed significantly higher Sdc-1 concentrations after 60 min of HOPE compared to grafts exhibiting normal postoperative function (P=0.02). Receiver operating characteristic analysis revealed a strong predictive potential with an area under the curve of 0.73. A cut-off at 808 ng/mL Sdc-1 at 60 min of HOPE allowed identification of a high-risk group with an incidence of EAD of 66.7%. Sdc-1 concentrations increased during all types of HOPE but were significantly higher in HOPE versus dual HOPE (D-HOPE) after 120 min of perfusion (P=0.02). Conclusions: Sdc-1 evaluated at 60 min during HOPE allows prediction of EAD after LT. Accordingly, Sdc-1 should be considered a potential additional biomarker for viability assessment during HOPE.

Study objective: Acute kidney injury (AKI) is a serious complication in postoperative ICU patients. The incidence of AKI varies substantially based on the type of surgery and definition used. This study focuses on the incidence of AKI in postoperative ICU patients using full KDIGO criteria and related outcomes regarding to different types of surgery. Design: Retrospective cohort study. Setting: Tertiary level university hospital, eight anaesthesiological/surgical ICUs, between 2016 and 2018. Patients: 6261 adult patients. Measurements: Primary outcome was 28-day all-cause mortality in different stages of AKI according to complete KDIGO criteria. Main results: We found 3497 (55.9%) postoperative ICU patients with AKI. The severity distribution of AKI stage 1 to 3 was 19.7%, 28.4% and 7.8%, respectively, and 235 (4%) patients received RRT. The 28-day mortality was 3% (n = 205). Increasing AKI severity was associated with increased 28-day mortality when adjusted for other variables (AKI 2 degrees: OR 2.81; 95% CI 1.55 to 5.24; p < 0.001 and AKI 3 degrees: OR 11.37.; 95% CI 5.91 to 22.55; p < 0.001). Besides AKI stages 2 and 3, age (OR 1.02; 95% CI 1.01 to 1.04, p < 0.001), NYHA IV (OR 2.23; 95% CI 1.03 to 4.43, p = 0.042), need for surgical reintervention within 48 h (OR 2.92; 95% CI 1.76 to 4.72, p = 0.001), urgent surgery (OR 1.78; 95% CI 1.15 to 2.71, p = 0.01), emergency surgery (OR 2.63; 95% CI 1.58 to 4.31, p = 0.001), vascular surgery (OR 2.01; 95% CI 1.06 to 3.98, p = 0.033), and orthopedic and trauma surgery (OR 3.79; 95% CI 1.98 to 7.09, p < 0.001) versus cardiac surgery was significantly associated with increased risk for 28-days mortality in multivariate analysis. Conclusion: AKI based on full KDIGO criteria is very common in postoperative ICU patients and it is associated with stepwise increase in 28-days mortality.

BACKGROUND Prone positioning has become a standard therapy in acute respiratory distress syndrome to improve oxygenation and decrease mortality. However, little is known about prone positioning in lung transplant recipients. This large, singe-center analysis investigated whether prone positioning improves gas exchange after lung transplantation. METHODS Clinical data of 583 patients were analyzed. Prone position was considered in case of impaired gas exchange Pa O2 /fraction of oxygen in inhaled air (<250), signs of edema after lung transplantation, and/or evidence of reperfusion injury. Patients with hemodynamic instability or active bleeding were not proned. Impact of prone positioning (n = 165) on gas exchange, early outcome and survival were determined and compared with patients in supine positioning (n = 418). RESULTS Patients in prone position were younger, more likely to have interstitial lung disease, and had a higher lung allocation score. Patients were proned fora median of 19 hours (interquartile range,15-26) hours). They had significantly lower Pa O2 /fraction of oxygen in inhaled air (227 +/- 96 vs 303 +/- 127 mm Hg, P = .004), and lower lung compliance (24.8 +/- 9.1 mL/mbar vs 29.8 +/- 9.7 mL/mbar, P < .001) immediately after lung transplantation. Both values significantly improved after prone positioning for 24 hours (Pa O2 /fraction of oxygen ratio: 331 +/- 91 mm Hg; lung compliance: 31.7 +/- 20.2 mL/ mbar). Survival at 90 days was similar between the 2 groups (93% vs 96%, P = .105). CONCLUSIONS Prone positioning led to a significant improvement in lung compliance and oxygenation after lung transplantation. Prospective studies are needed to confirm the benefit of prone positioning in lung transplantation. (Ann Thorac Surg 2024;117:1045-52) (c) 2024 The Authors. Published by Elsevier Inc. on behalf of The Society of Thoracic Surgeons. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Extracellular vesicles (EVs) represent nanometer-sized, subcellular spheres, that are released from almost any cell type and carry a wide variety of biologically relevant cargo. In severe cases of coronavirus disease 2019 (COVID-19) and other states of systemic pro-inflammatory activation, EVs, and their cargo can serve as conveyors and indicators for disease severity and progression. This information may help distinguish individuals with a less severe manifestation of the disease from patients who exhibit severe acute respiratory distress syndrome (ARDS) and require intensive care measures. Here, we investigated the potential of EVs and associated miRNAs to distinguish normal ward patients from intensive care unit (ICU) patients ( N = 10/group), with 10 healthy donors serving as the control group. Blood samples from which plasma and subsequently EVs were harvested by differential ultracentrifugation (UC) were obtained at several points in time throughout treatment. EV-enriched fractions were characterized by flow cytometry (FC), nanoparticle tracking analysis (NTA), and qPCR to determine the presence of selected miRNAs. Circulating EVs showed specific protein signatures associated with endothelial and platelet origin over the course of the treatment. Additionally, significantly higher overall EV quantities corresponded with increased COVID-19 severity. MiR-223-3p, miR-191-5p, and miR-126-3p exhibited higher relative expression in the ICU group. Furthermore, EVs presenting endothelial-like protein signatures and the associated miR-126-3p showed the highest area under the curve in terms of receiver operating characteristics regarding the requirement for ICU treatment. In this exploratory investigation, we report that specific circulating EVs and miRNAs appear at higher levels in COVID-19 patients, especially when critical care measures are indicated. Our data suggest that endothelial-like EVs and associated miRNAs likely represent targets for future laboratory assays and may aid in clinical decision-making in COVID-19.

Introduction: The endothelial glycocalyx is mainly consisting of Syndecan-1 (Sdc-1) which is released into human serum upon glycocalyx degradation. Glycocalyx alterations are connected to different aspects of organ damage and have been recently investigated in the context of liver transplantation. Due to shortage of donor organs, new preservation methods as hypothermic oxygenated machine perfusion (HOPE) have been introduced to enable transplantation of organs with a higher risk profile. For safe expansion of the donor pool, reliable organ assessment markers for evaluation during machine perfusion are missing. We aimed to measure glycocalyx damage during hypothermic liver perfusion. Methods: HOPE was performed with the Organ Assist® perfusion system on 40 livers, prior to organ transplantation. Samples were collected during (perfusate at 0 and 60 min) and after HOPE (effluent). Sdc-1 concentration in samples was measured by ELISA as indicator for glycocalyx destruction. We compared clinical parameters with Sdc-1 levels in patients regarding the development of early allograft dysfunction (EAD) using Mann-Whitney U test, Pearson correlation and receiver operating characteristics (ROC). Results: The 13 patients which developed EAD, showed an elevation in Sdc-1 concentration compared to non-EAD patients during HOPE at 0 min: [598 (±526) vs. 276 (±150) ng/ml; p=0.076] and 60 min: [1099 (±739) vs. 521 (±382) ng/ml; p=0.016], as well as afterwards in the effluent: [2074 (±1273) vs. 443 (±226) ng/ml; p=0.001 (n=15, 4 with EAD)]. Concentration of Sdc-1 during HOPE correlated with EAD at 0 min: (R=0.433, p=0.006), at 60 min: (R=0.471, p=0.003) and in the effluent: (R=0.769, p<0.001, n=15, 4 with EAD). Furthermore, an association between EAD and Sdc-1 concentrations was indicated by ROCs: during HOPE at 60 minutes: (AUC=0.704 and p=0.018) and in the effluent: (AUC=1 and p=0.004 (n=15, 4 with EAD)). No association of graft survival with Sdc-1 (p=0.339) was detected in cox regression analysis however, reduced graft survival (log-rank=0.009) of EAD patients compared to those without EAD could be shown. Conclusion: We found that measuring glycocalyx degradation during HOPE could indicate transplantation outcome regarding EAD. Consequently, we argue that Sdc-1 could be a useful biomarker for organ assessment during HOPE.

Background: We investigated the dynamics and the predictive value of soluble syndecan-1 (Sdc-1), a biomarker of endothelial dysfunction, in uneventful pregnancies and pregnancies complicated by preeclampsia (PE). Methods: Serum levels of Sdc-1 were measured at sequential time points during and after uneventful pregnancies (control, n =95) and pregnancies developing PE (PE_long, n =12). Levels were further measured in women with symptomatic PE (PE state, n =46) at a single time point. Results: Sdc-1 levels increased consistently throughout pregnancy. In the PE_long group Sdc-1 levels were lower at all visits throughout pregnancy, and reached significance in weeks 18-22 (p = 0.019), 23-27 (p = 0.009), 28-32 (p = 0.006) and 33-36 (p = 0.008). After delivery, Sdc-1 levels dropped sharply in all pregnancies but were significantly elevated in the PE_long group. The predictive power of Sdc-1 was evaluated analyzing receiver operating characteristic (ROC) curves. A significant power was reached at weeks 14-17 (area under the curve [AUC] 0.65, p =0.025), 23-27 (AUC 0.73, p =0.004) and 33-36 (AUC 0.75, p =0.013). Conclusions: In summary, Sdc-1 levels were lower in women developing PE compared to uneventful pregnancies and Sdc-1 might be useful to predict PE. After delivery, Sdc-1 levels remained higher in women with PE. Additional studies investigating the link between glycocalyx degradation, Sdc-1 levels and placental and endothelial dysfunction in pregnancies affected by PE are warranted.

Increased concentrations of the vasodilator histamine have been observed in patients undergoing abdominal surgery. The role of histamine during orthotopic liver transplantation (OLT) has only been studied in animals. The aim of this study was to measure plasma concentrations of histamine and its degrading enzyme diamine oxidase (DAO) in patients undergoing orthotopic liver transplantation, and assess whether histamine or DAO correlate with intraoperative noradrenaline requirements. Histamine and DAO concentrations were measured in 22 adults undergoing liver transplantation and 22 healthy adults. Furthermore, norepinephrine requirements during liver transplantation were recorded. Baseline concentrations of histamine and DAO were greater in patients, who underwent liver transplantation, than in healthy individuals (Histamine: 6.4 nM, IQR[2.9–11.7] versus 4.3 nM, IQR[3.7–7.1], p = 0.029; DAO: 2.0 ng/mL, IQR[1.5–4.1] versus <0,5 ng/mL, IQR[<0.5–1.1], p < 0.001). During liver transplantation, histamine concentrations decreased to 1.8 nM, IQR[0.5–4.9] in the anhepatic phase (p < 0.0001 versus baseline), and to 1.5 nM, IQR[0.5–2.9] after reperfusion (p < 0.0001 versus baseline). In contrast, DAO concentrations increased to 35.5 ng/ml, IQR[20–50] in the anhepatic phase (p = 0.001 versus baseline) and to 39.5 ng/ml, IQR[23–64] after reperfusion (p = 0.001 versus baseline), correlating inversely with histamine. Norepinephrine requirements during human liver transplantation correlated significantly with DAO concentrations in the anhepatic phase (r = 0.58, p = 0.011) and after reperfusion (r = 0.56; p = 0.022). In patients undergoing orthotopic liver transplantation, histamine concentrations decrease whereas DAO concentrations increase manifold. Diamine oxidase correlates with intraoperative norepinephrine requirements in patients undergoing OLT.

We report a case of tick-borne encephalitis (TBE) in a 22-year-old man, who was admitted to the Medical University of Vienna hospital with severe meningoencephalitis, unresponsive and dependent on a respirator. He had given a history of a recent tick bite, but because he had previously received a full course of vaccination against TBE, West Nile virus infection was suspected. Because the antiviral drug favipiravir has been reported to be active against WNV, therapy was initiated, and continued even after a diagnosis of TBE was confirmed, due to significant improvement of symptoms. Within days, the patient's symptoms resolved, and he was discharged after complete recovery at 15 days after onset. Although this single case does not permit any conclusion as to the role of favipiravir in the favorable outcome, it suggests that the drug should be further evaluated in laboratory animal models and in appropriate clinical settings.

Objectives: The primary objective was to determine the impact of infant positioning on cardiopulmonary resuscitation performance during simulated pediatric cardiac arrest. Design: A single-center, prospective, randomized, unblinded manikin study. Setting: Medical university-affiliated simulation facility. Subjects: Fifty-two first-line professional rescuers (n = 52). Interventions: Performance of cardiopulmonary resuscitation was determined using an infant manikin model in three different positions (on a table [T], on the provider’s forearm with the manikin’s head close to the provider’s elbow [P], and on the provider’s forearm with the manikin’s head close to the provider’s palm [D]). For the measurement of important cardiopulmonary resuscitation performance variables, a commercially available infant simulator was modified. In a randomized sequence, healthcare professionals performed single-rescuer cardiopulmonary resuscitation for 3 minutes in each position. Performances of chest compression (primary outcome), ventilation, and hands-off time were analyzed using a multilevel regression model. Measurements and Main Results: Mean (± sd) compression depth significantly differed between table and the other two manikin positions (31 ± 2 [T], 29 ± 3 [P], and 29 ± 3 mm [D]; overall p < 0.001; repeated measures design adjusted difference: T vs P, –2 mm [95% CI, –2 to –1 mm]; T vs D, –1 mm [95% CI, –2 to –1 mm]). Secondary outcome variables showed no significant differences. Conclusions: Compressions were significantly deeper in the table group compared to positions on the forearm during cardiopulmonary resuscitation, yet the differences were small and perhaps not clinically important.

The product of the concentrations of urinary tissue inhibitor of metalloproteinases-2 and insulin-like growth factor binding protein-7 (urinary [TIMP-2] × [IGFBP-7]) has been suggested as biomarker for early detection of acute kidney injury (AKI) in various clinical settings. However, the performance of urinary [TIMP-2] × [IGFBP-7] to predict AKI has never been assessed in patients undergoing orthotopic liver transplantation (OLT). Thus, the aim of this study was to assess the early predictive value of urinary [TIMP-2] × [IGFBP-7] for the development of AKI after OLT. In this observational study, urinary [TIMP-2] × [IGFBP-7] was measured in samples from adult OLT patients. AKI was diagnosed and classified according to KDIGO criteria. Areas under the receiver operating curves (AUC) were calculated to assess predictive values of urinary [TIMP-2] × [IGFBP-7] for the development of AKI. Forty patients (mean age 55 ± 8 years) were included. Twenty-eight patients (70%) developed AKI stage 1, 2, or 3 within 48 h after OLT. Urinary [TIMP-2] × [IGFBP-7] was not predictive for AKI at the end of OLT (AUC: 0.54, CI [0.32–0.75], P = 0.72), at day 1 (AUC: 0.60, CI [0.41–0.79], P = 0.31), or day 2 after OLT (AUC: 0.63, CI [0.46–0.8], P = 0.18). Based on our results, routine clinical use of urinary [TIMP-2] × [IGFBP-7] cannot be recommended for risk assessment of AKI in patients undergoing OLT.

Background. Destruction of the endothelial glycocalyx has been observed within lung and kidney grafts during ischemic organ preservation. We aimed to quantify glycocalyx damage within human liver grafts after organ preservation and correlate the results with graft injury and postoperative graft function in patients undergoing orthotopic liver transplantation (OLT). Methods. Syndecan-1 (Sdc-1) was measured as indicator of glycocalyx degradation in effluents of 38 liver grafts and serum of patients undergoing OLT. Effluent Sdc-1 concentrations were correlated with hepatic injury markers from the effluent. Furthermore, we assessed the association of Sdc-1 with early allograft dysfunction (EAD), 1-year graft survival, and 1-year patient survival. Results. Effluent Sdc-1 concentrations correlated with effluent concentrations of hepatocellular injury markers, including alkaline phosphatase (R = 0.543, P = 0.003), aspartate aminotransferase (R = 0.420, P = 0.029), and lactate (R = 0.574, P = 0.002). Sdc-1 effluent concentrations were greater in patients who developed EAD compared with those without EAD (4720 [4374-5133] vs 3838 [3202-4240] ng/mL, P = 0.015). Furthermore, receiver operating characteristics analyses revealed that effluent Sdc-1 concentrations (AUC = 0.82, P = 0.017) and serum Sdc-1 concentrations (AUC = 0.84, P = 0.006) were associated with the development of EAD. These results were confirmed by regression analyses. No association was found between Sdc-1 and 1-year graft survival or 1-year patient survival. Conclusions. Our data suggest that the glycocalyx is damaged within human liver grafts during preservation and the extent of glycocalyx damage correlates with the severity of hepatocellular injury. Recipients of livers grafts with greater glycocalyx damage might be at higher risk for development of EAD after OLT.

Background: Elevated concentrations of D-dopachrome tautomerase (D-DT) were associated with adverse outcome in various clinical settings. However, no study assessed D-DT concentrations in patients requiring orthotopic liver transplantation (OLT). The aim of this observational study was to measure serum D-DT concentrations in patients undergoing OLT and associate D-DT with survival and acute kidney injury (AKI). Methods: Forty-seven adults with end-stage liver disease undergoing OLT were included. Areas under the receiver operating curves (AUC) were calculated to assess predictive values of D-DT for outcome and AKI after OLT. Survival was analyzed by Kaplan-Meier curves. Results: Serum D-DT concentrations were greater in non-survivors than in survivors prior to OLT (86 [50-117] vs. 53 [31-71] ng/ml, P = 0.008), and on day 1 (357 [238-724] vs. 189 [135-309] ng/ml, P = 0.001) and day 2 (210 [142-471] vs. 159 [120-204] ng/ml, P = 0.004) following OLT. Serum D-DT concentrations predicted lethal outcome when measured preoperatively (AUC = 0.75, P = 0.017) and on postoperative day 1 (AUC = 0.75, P = 0.015). One-year survival of patients with preoperative D-DT concentrations >85 ng/ml was 50%, whereas that of patients with preoperative D-DT concentrations <85 ng/ml was 83% (Chi(2) = 5.83, P = 0.016). In contrast, D-DT was not associated with AKI after OLT. Conclusion: In patients undergoing OLT, serum D-DT might predict outcome after OLT.