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Liver transplant anesthesiology

Axel Andres, Pietro Majno, Sylvain Terraz, Philippe Morel, Arnaud Roth, Laura Rubbia-Brandt, Eduardo Schiffer, Frederic Ris, Christian Toso
Colorectal liver metastasis (CRLM) is the most frequent indication for liver resection in many centers. Recent improvements in oncology, surgery, interventional radiology, pathology and anesthesiology allow curative treatment in a larger proportion of patients with CRLM. Areas covered: We illustrate the various aspects of the management of CRLM through 11 questions that summarize the topic, from the current obtained survival to future perspectives such as transplantation. The limits of a curative treatment are also presented from different angles, such as the benefits of pathology, the surgical options for extreme resections, the available chemotherapies and their efficacy, or the non-surgical ablative treatments...
October 17, 2016: Expert Review of Anticancer Therapy
V Perilli, P Aceto, T Sacco, C Modesti, P Ciocchetti, F Vitale, A Russo, G Fasano, A Dottorelli, L Sollazzi
Graft and patients survival are the main goal of anesthesiological management in patients undergoing liver transplantation (LT). Even if anesthesiological practice sustained major developments over time, some evidence-based intraoperative strategies have not yet been widely applied. The aim of this review was to summarize intraoperative anesthesiological strategies which could have the potential to improve LT graft and/or recipient survival. Monitoring must be as accurate as possible in order to manage intraoperative hemodynamic changes...
July 2016: European Review for Medical and Pharmacological Sciences
I Freytag, J Bucher, M Schoenberg, M Stangl, G Schelling
We report a case of a 27-year-old anesthetist who acquired tuberculosis (TB) while performing general anesthesia in a renal transplant (RTX) patient who had donor-derived contagious TB. The anesthetist developed pleural TB 6 months after exposure. Contact investigations (CIs) did not include health care workers (HCWs) of the Department of Anesthesiology, thereby missing the opportunity for the early diagnosis and treatment of TB. Genomic fingerprinting revealed identical Mycobacterium tuberculosis (MT) isolates in the anesthetist and in the RTX patient...
May 2016: Der Anaesthesist
J L A van Vugt, S Levolger, R W F de Bruin, J van Rosmalen, H J Metselaar, J N M IJzermans
Liver transplant outcome has improved considerably as a direct result of optimized surgical and anesthesiological techniques and organ allocation programs. Because there remains a shortage of human organs, strict selection of transplant candidates remains of paramount importance. Recently, computed tomography (CT)-assessed low skeletal muscle mass (i.e. sarcopenia) was identified as a novel prognostic parameter to predict outcome in liver transplant candidates. A systematic review and meta-analysis on the impact of CT-assessed skeletal muscle mass on outcome in liver transplant candidates were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines...
August 2016: American Journal of Transplantation
Serkan Öcal, Özgür Harmancı, Fatih Ensaroğlu, Murat Korkmaz, Haldun Selçuk, Fatih Hilmioğlu, Gökhan Moray, Mehmet Haberal
OBJECTIVES: We report the outcomes of endoscopic retrograde cholangiopancreatography procedures performed for diagnostic and therapeutic purposes in patients who had undergone kidney transplant. MATERIALS AND METHODS: We retrospectively evaluated the records of kidney transplant patients for January 1993 to December 2014. Endoscopic retrograde cholangiopancreatography was carried out using an Olympus JF240 duodenoscope (tip outer diameter 12.6 mm, working channel diameter 3...
November 2015: Experimental and Clinical Transplantation
Jan Benes, Jan Zatloukal, Jakub Kletecka
Viscoelastic methods (VEM) made available the bedside assessment of blood clotting. Unlike standard laboratory tests, the results are based on the whole blood coagulation and are available in real time at a much faster turnaround time. In combination with our new knowledge about pathophysiology of the trauma-induced coagulopathy, the goal-oriented treatment protocols have been recently proposed for the initial management of bleeding in trauma victims. Additionally, the utility of viscoelastic monitoring devices has been proved even outside this setting in cardiosurgical patients or those undergoing liver transplantation...
2015: Frontiers in Medicine
L J Ceulemans, I Jochmans, D Monbaliu, M Verhaegen, W Laleman, F Nevens, S Heye, G Maleux, J Pirenne
Multivisceral transplantation (MvTx) for diffuse venous portomesenteric thrombosis is a surgically and anesthesiologically challenging procedure, partly because of the risk of massive bleeding during visceral exenteration. Preoperative visceral artery embolization might reduce this risk. In three consecutive MvTx, the celiac trunk (CT) and superior mesenteric artery (SMA) were embolized immediately pretransplant. We analyzed demographics, serum D-lactate, pH, base excess, hemoglobin, blood pressure, transfused packed cell (PC) units, intervention time and outcome...
November 2015: American Journal of Transplantation
Dung Nguyen, Shira Gurvitz-Gambrel, Paul A Sloan, Jeremy S Dority, Amy DiLorenzo, Zaki-Udin Hassan, Annette Rebel
The objective of this study was to assess whether resident exposure to liver transplantation anesthesia results in improved patient care during a simulated critical care scenario. Our hypothesis was that anesthesia residents exposed to liver transplantation anesthesia care would be able to identify and treat a simulated hyperkalemic crisis after reperfusion more appropriately than residents who have not been involved in liver transplantation anesthesia care. Participation in liver transplantation anesthesia is not a mandatory component of the curriculum of anesthesiology training programs in the United States...
April 2015: International Surgery
M Ucar, U Ozgül, A Polat, H I Toprak, M A Erdogan, M S Aydogan, M Durmus, M O Ersoy
BACKGROUND: The safety of healthy volunteer donors is one of the most important issues in living-donor liver transplantation. Use of the Pringle maneuver during donor hepatectomy can result in liver ischemia-reperfusion (IR) injury. The objective of this study was to examine the effects of isoflurane and propofol on IR injury caused by the Pringle maneuver during donor hepatectomy. METHODS: A total of 70 American Society of Anesthesiology I-II donors aged 18-65 years who underwent hepatectomy were included in the study...
March 2015: Transplantation Proceedings
Antoine Monsel, Ying-Gang Zhu, Stephane Gennai, Qi Hao, Jia Liu, Jae W Lee
Critically ill patients often suffer from multiple organ failures involving lung, kidney, liver, or brain. Genomic, proteomic, and metabolomic approaches highlight common injury mechanisms leading to acute organ failure. This underlines the need to focus on therapeutic strategies affecting multiple injury pathways. The use of adult stem cells such as mesenchymal stem or stromal cells (MSC) may represent a promising new therapeutic approach as increasing evidence shows that MSC can exert protective effects following injury through the release of promitotic, antiapoptotic, antiinflammatory, and immunomodulatory soluble factors...
November 2014: Anesthesiology
Fabrizio Panaro, Jeanne Ramos, Benoit Gallix, Grégoire Mercier, Astrid Herrero, Halidou Niampa, Georges-Philippe Pageaux, Francis Navarro
BACKGROUND: Transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) may cause damage to the hepatic artery (HA) and impact the postoperative course of the liver transplantation (LT). We aim to describe the relationship between preoperative TACE and the occurrence of histological and radiological hepatic artery complications (HAC). METHODS: All cirrhotic patients with HCC undergoing LT between January 2009 and October 2012 were included and divided in two groups: TACE (group 1) and No TACE (group 2)...
May 2014: Clinical Transplantation
Patrick J Hackett, Marina Guirguis, Nozomi Sakai, Tetsuro Sakai
Only 20.5% to 61.6% of abstracts presented at biomedical meetings are subsequently published as full-length articles. The aim of this study was to analyze the abstract-to-publication rate of International Liver Transplantation Society (ILTS) meeting abstracts. Abstracts presented at 5 consecutive annual ILTS meetings (2004-2008) were included to ensure a minimum follow-up period of 4 years. For each abstract, a PubMed Central search was conducted with the first author's name and affiliation along with keywords from the title...
March 2014: Liver Transplantation
Wayne Soong, Saadia S Sherwani, Michael L Ault, Andrew M Baudo, Joshua C Herborn, Andre M De Wolf
OBJECTIVE: To characterize contemporary practice patterns in the use of transesophageal echocardiography during adult liver transplantation and to identify factors preventing more frequent use. DESIGN: Online questionnaire. SETTING: Liver transplantation centers in the United States performing 12 or more adult liver transplants in 2011. PARTICIPANTS: One representative from each qualifying center: The transplant anesthesiology director, a transplant anesthesiologist personally known to the authors, or the department of anesthesiology chair...
June 2014: Journal of Cardiothoracic and Vascular Anesthesia
Paolo Feltracco, Cristiana Carollo, Stefania Barbieri, Tommaso Pettenuzzo, Carlo Ori
The poor clinical conditions associated with end-stage cirrhosis, pre-existing pulmonary abnormalities, and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation (OLT) surgery. Many intraoperative and postoperative events, such as fluid overload, massive transfusion of blood products, hemodynamic instability, unexpected coagulation abnormalities, renal dysfunction, and serious adverse effects of reperfusion syndrome, are other factors that predispose an individual to postoperative respiratory disorders...
December 28, 2013: World Journal of Gastroenterology: WJG
Allan F Simpao, Jorge A Galvez, Alan Jay Schwartz, Mohamed A Rehman
No abstract text is available yet for this article.
January 2015: Anesthesiology
Roman Schumann, M Susan Mandell, Nathan Mercaldo, Damon Michaels, Amy Robertson, Arna Banerjee, Ramachander Pai, John Klinck, Pratik Pandharipande, Ann Walia
STUDY OBJECTIVE: To determine current practice patterns for patients receiving liver transplantation. DESIGN: International, web-based survey instrument. SETTING: Academic medical centers. MEASUREMENTS: Survey database responses to questions about liver transplant anesthesiology programs and current intraoperative anesthetic care and resource utilization were assessed. Descriptive statistics of intraoperative practices and resource utilization according to the size of the transplant program were recorded...
November 2013: Journal of Clinical Anesthesia
R Schumann, S Mandell, M D Michaels, J Klinck, A Walia
BACKGROUND: Volume resuscitation and use of vasoactive medications during liver transplantation has not been systematically assessed. Furthermore, the anesthesiologist's role for intraoperative oversight of technologies such as renal replacement therapy and procedures such as venovenous bypass is poorly defined, and it is unclear if the center's annual transplant frequency affects these practices. METHODS: We conducted a database analysis of the Liver Transplant Anesthesia Consortium survey 202 that addresses these questions...
July 2013: Transplantation Proceedings
M Susan Mandell, Elizabeth A Pomfret, Randall Steadman, Ryutaro Hirose, David J Reich, Roman Schumann, Ann Walia
A new Organ Procurement and Transplantation Network/United Network for Organ Sharing bylaw recommends that all centers appoint a director of liver transplant anesthesia with a uniform set of criteria. We obtained survey data from the Liver Transplant Anesthesia Consortium so that we could compare existing criteria for a director in the United States with the current recommendations. The data set included responses from adult academic liver transplant programs before the new bylaw. The respondent rates were within statistical limits to exclude sampling bias...
April 2013: Liver Transplantation
Paolo Feltracco, Marialuisa Brezzi, Stefania Barbieri, Helmut Galligioni, Moira Milevoj, Cristiana Carollo, Carlo Ori
Blood loss during liver transplantation (OLTx) is a common consequence of pre-existing abnormalities of the hemostatic system, portal hypertension with multiple collateral vessels, portal vein thrombosis, previous abdominal surgery, splenomegaly, and poor "functional" recovery of the new liver. The intrinsic coagulopathic features of end stage cirrhosis along with surgical technical difficulties make transfusion-free liver transplantation a major challenge, and, despite the improvements in understanding of intraoperative coagulation profiles and strategies to control blood loss, the requirements for blood or blood products remains high...
January 27, 2013: World Journal of Hepatology
Alexander Choukèr, Akio Ohta, André Martignoni, Dmitriy Lukashev, Lefteris C Zacharia, Edwin K Jackson, Jürgen Schnermann, Jerrold M Ward, Ines Kaufmann, Brenda Klaunberg, Michail V Sitkovsky, Manfred Thiel
BACKGROUND: Liver ischemia-reperfusion injury (IRI) is a known risk factor for the postoperative outcome of patients undergoing liver surgery/transplantation. Attempts to protect from organ damage require multidisciplinary strategies and are of emerging interest in view of patients with higher age and American Society of Anesthesiology status. Ischemic preconditioning has been successfully applied to prevent from IRI during liver resection/transplantation. Because even short periods of ischemia during preconditioning inevitably lead to hypoxia and formation of anti-inflammatory/cytoprotective acting adenosine, we reasoned that short nonischemic hypoxia also protects against hepatic IRI...
November 15, 2012: Transplantation
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