title: Adenosine Increases Hepatic Artery Flow in Liver Transplant Recipients: A Pilot Study.
abstract: BACKGROUND
  The aim of this study was to assess the effect of low-dose adenosine on hepatic artery flow (HAF) when administered intraoperatively by continuous infusion.
  
  
  METHODS
  Between January 2009 and August 2009, 74 patients underwent orthotopic liver transplantation (OLT). Ten patients were enrolled for adenosine treatment, and 64 non-study patients served as controls. After arterial reperfusion, a 16-G central venous catheter was placed in the gastroduodenal artery, and adenosine was continuously infused at doses ranging from 0.7 to 2.8 μg/kg/min for 30 min. HAF and portal vein flow were measured using a transit time flow meter before adenosine infusion, during infusion, and 10 min after infusion. Liver function tests were monitored routinely, duplex ultrasonography was performed on postoperative day 1, and the hepatic artery resistive index measured. The patients were followed for 1 year.
  
  
  RESULTS
  Adenosine significantly increased HAF at doses from 0.7 to 2.8 μg/kg/min. The smallest increase in HAF was 24% above the baseline; in 80% of patients, the increase in HAF was >50% of the baseline values. In 2 patients, HAF was increased by >300%. The dosing started at 0.7 μg/kg/min, and 6 of 10 patients responded. Three patients required an increase to 1.4 μg/kg/min. Doses >2.8 μg/kg/min did not further increase HAF. One patient showed a minimal response regardless of the dose. There were no differences between the adenosine group and control group with respect to liver function (aspartate aminotransferase, alanine aminotransferase, total bilirubin, and International Normalized Ratio), platelet count on POD2, hepatic artery resistive index, and post-transplant length of stay, intensive care days, or 1-year patient survival rates.
  
  
  CONCLUSIONS
  This pilot study established that adenosine administered directly into the hepatic artery produces a similar effect on HAF in cadaveric liver transplant recipients to that found in the laboratory without producing systemic side effects.
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA; Department of General Surgery, The Affiliated Hospital of Xuzhou Medical College, Jiangsu, China. Electronic address: zxchl@yahoo.com.
authors.forename: X
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: H
authors.initials: H
authors.lastname: Shiba
authors.affiliation: Department of General Surgery, The Affiliated Hospital of Xuzhou Medical College, Jiangsu, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: C
authors.initials: C
authors.lastname: Quintini
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: B
authors.initials: B
authors.lastname: Eghtesad
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: C
authors.initials: C
authors.lastname: Miller
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Fung
authors.affiliation: Department of General Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Kelly
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D058625:End Stage Liver Disease / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006499:Hepatic Artery / Q000187:drug effects / Q000503:physiopathology*; D006801:Humans; D007262:Infusions, Intravenous; D008102:Liver Circulation / Q000187:drug effects*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012039:Regional Blood Flow / Q000187:drug effects* / Q000502:physiology; D066027:Transplant Recipients; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine