title: Use of Methylene Blue to Treat Hypovolemic Shock Followed by Ischemia-Reperfusion Injury in the Postoperative Orthotopic Liver Transplant Patient: A Case Report.
abstract: A 57-year-old female patient received elective liver transplant due to nonalcoholic steatohepatitis complicated by hepatocellular carcinoma. Her preoperative Model for End-Stage Liver Disease score was 11. The total transplant ischemic time was 10 hours and 35 minutes, and the warm ischemic time was 35 minutes. Even with aggressive fluid overload and use of high concentrations of vasoactive amines, the patient developed possible primary graft dysfunction with poor response to fluids and vasopressor support, suggesting vasoplegic syndrome. On the basis of the hypothesis of vasoplegic syndrome, the patient received methylene blue intravenously (100 mg bolus for 12 h/1.5 mg/kg). The catastrophic situation was controlled. The patient's urine output markedly improved, she was subsequently weaned from vasoactive support, and mechanical ventilation was discontinued 2 days later. The patient was discharged on the 20th postoperative day.
authors: From the Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors: Kelvin Henrique
authors: KH
authors: Vilalva
authors: Fabrícia Teixeira
authors: FT
authors: Mumic
authors: Marina Rodrigues Garcia
authors: MRG
authors: Silveira
authors: Enio David
authors: ED
authors: Mente
authors: Paulo Roberto Barbosa
authors: PRB
authors: Evora
authors: Orlando
authors: O
authors: Castro E Silva
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008751:Methylene Blue / Q000627:therapeutic use*; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000601:surgery*; D015427:Reperfusion Injury / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012769:Shock / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome; D056987:Vasoplegia / Q000188:drug therapy / Q000209:etiology
chemical_list: D008751:Methylene Blue