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BACKGROUND: There is no consensus on the usage of extended criteria donor (ECD) grafts in liver transplantation (LT) for acute-on-chronic liver failure (ACLF) patients. AIM: To summarize the experience of using ECD livers in ACLF-LT. METHODS: A retrospective cohort study was conducted, enrolling patients who underwent LT at the First Affiliated Hospital of Sun Yat-Sen University from January 2015 to November 2021. The patients were divided into ECD and non-ECD groups for analysis. RESULTS: A total of 145 recipients were enrolled in this study, of which ECD and non-ECD recipients accounted for 53.8% and 46.2%, respectively. Donation after cardiac death (DCD) recipients accounted for the minority compared with donation after brain death (DBD) recipients (16.6% vs 83.4%). Neither overall survival nor graft survival significantly differed between ECD and non-ECD and DCD and DBD recipients. ECD grafts were associated with a significantly higher incidence of early allograft dysfunction (EAD) than non-ECD grafts (67.9% vs 41.8%, P = 0.002). Postoperative outcomes between DCD and DBD recipients were comparable (P > 0.05). ECD graft (P = 0.009), anhepatic phase (P = 0.034) and recipient gamma glutamyltransferase (P = 0.016) were independent risk factors for EAD. Recipient preoperative number of extrahepatic organ failures > 2 (P = 0.015) and intraoperative blood loss (P = 0.000) were independent predictors of poor post-LT survival. CONCLUSION: Although related to a higher risk of EAD, ECD grafts can be safely used in ACLF-LT. The main factors affecting post-LT survival in ACLF patients are their own severe preoperative disease and intraoperative blood loss.
Asunto(s)
Insuficiencia Hepática Crónica Agudizada , Trasplante de Hígado , Obtención de Tejidos y Órganos , Humanos , Trasplante de Hígado/efectos adversos , Insuficiencia Hepática Crónica Agudizada/cirugía , Insuficiencia Hepática Crónica Agudizada/etiología , Estudios Retrospectivos , Pérdida de Sangre Quirúrgica , Selección de Donante , Donantes de Tejidos , Muerte Encefálica , Supervivencia de Injerto , MuerteRESUMEN
An interesting procedure for the oxidative cleavage of benzylic C-N bonds has been developed. Using TBAI as the catalyst and H2O2 as the oxidant, various benzylamines were transformed into their corresponding aromatic aldehydes in moderate to good yields. Notably, this is the first example of an oxidative cleavage of benzylic C-N bonds under metal-free conditions.
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Recent achievements in the use of TBAI (tetrabutylammonium iodide) and TBHP (tert-butyl hydroperoxide) as an oxidation system have been summarized and discussed.
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An interesting procedure for the oxidative synthesis of amides from styrenes and amines has been developed. Various primary amides were formed in moderate yields (25-81%). Secondary amides can be produced in moderate yields as well (41-68%). Notably, no transition metal catalyst was needed for this transformation. This is the first example of oxidative transformation of styrenes to benzamides.