Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery

Herborn, Joshua; Parulkar, Suraj

doi:10.1016/j.anclin.2017.04.009

Cited by 14 publications

(23 citation statements)

References 64 publications

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“…There are several reports demonstrating efficient outcomes in this patient group for the hip or knee replacement surgery [5][6][7]. Additionally, the establishment of minimally invasive surgical techniques and regional blocks especially in patients with organ failure increases the success rate of surgeries in this specific patient group [8,9]. Our results present additional data for the literature stating that transplanted subjects might be treated for spinal fusion and instrumentation without major side effects.…”

Section: Discussionmentioning

confidence: 56%

Evaluation of spinal instrumentation following organ transplantation: A retrospective cohort study

Mert¹,

Ermutlu²

2020

Journal of Surgery and Medicine

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Aim: Improvements in transplantation medicine and surgery, anesthesiology, and postoperative care paved the way for successful procedures for transplant patients. The aim of the present study is to describe the results of surgical correction for spinal deformities in patients who underwent several types of organ transplantation. Methods: The study group consisted of ten patients with a history of organ transplantation who require spinal surgery with different etiologies. Seven (70%), two (20%) and one (10%) patient had lung, liver, and lung transplantations, respectively. The etiology for spinal surgery was spinal stenosis in six (60%), vertebra fracture in three (30%), and vertebral metastasis in one (10%) patient. Preintra-and postoperative radiological, clinical, and functional outcomes were noted. Results: The mean age of the patients was 57.1 (8.9) years, ranging between 38-62 years. Six of the patients were male, and four were female. Surgery time following the transplant surgery was 15.6 (2.1) months. The blood requirement in the operating room was 5.6 (0.8) units of erythrocyte suspension. Hospital length of stay was 8.5 (5.6) days following the spinal instrumentation surgery. Two patients had mild complications in the postoperative period. The preoperative VAS score significantly decreased from 6.4 (0.8) to 3.1 (1.6) after the surgery (P<0.001). Conclusions: Posterior spinal instrumentation on transplanted patients can be an effective treatment which improves the life quality of the patients. A multidisciplinary approach with an experienced team is highly required.

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Section: Discussionmentioning

confidence: 56%

Evaluation of spinal instrumentation following organ transplantation: A retrospective cohort study

Mert¹,

Ermutlu²

2020

Journal of Surgery and Medicine

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“…These patients are noted to have an increased incidence of metabolic disorders, anemia, acute kidney injury, mortality, and cardiovascular and cerebrovascular events during and after general anesthesia. [18][19][20] While additional precautions may be necessary to avoid perioperative complications, elective surgery, such as ESS, can be performed without detriment to the allograft function. Previous studies have also demonstrated that early ESS intervention reduces the risk of revision surgery and prevents further intervention.…”

Section: Discussionmentioning

confidence: 99%

“…One of the major concerns regarding transplant recipients undergoing ESS is the risk of general anesthesia. These patients are noted to have an increased incidence of metabolic disorders, anemia, acute kidney injury, mortality, and cardiovascular and cerebrovascular events during and after general anesthesia 18‐20 . While additional precautions may be necessary to avoid perioperative complications, elective surgery, such as ESS, can be performed without detriment to the allograft function.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Recalcitrant Chronic Rhinosinusitis in Organ Transplant Recipients

Candelo

Avila‐Castano

Verez

et al. 2023

Otolaryngol.--head neck surg.

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Objective Studies suggest that transplant patients are at risk for chronic rhinosinusitis (CRS). However, there is limited information in the literature regarding frequency and reasons for failure of adequate medical therapy. We aim to determine the risk factors associated with the development of medically recalcitrant CRS requiring endoscopic sinus surgery (ESS). Study Design Retrospective cohort. Setting Mayo Clinic. Methods This is a retrospective chart review of 925 transplant recipients seen at Mayo Clinic between 2017 and 2022. Inclusion criteria: (1) a rhinologic consultation after transplant and (2) clinical diagnosis of CRS. A total of 549 patients met the inclusion criteria and were divided based on the need for ESS versus successful treatment with medical therapy. Univariate and logistic regression analyses were performed to identify risk factors and predictive variables related to failure of medical therapy. Results Of the 549 patients, 201/549 (37%) had medically recalcitrant disease requiring ESS, while 348/549 (63%) were successfully treated with medical therapy Based on logistic regression, patients with recurrent acute rhinosinusitis in the pretransplant period were 8.68 more likely to have a recalcitrant disease (95% confidence interval, 3.72‐20.28, p < 0.0001). Some of the largest determinants of medical therapy failure in the posttransplant period were CRS with nasal polyps, odontogenic CRS, and noninvasive fungal sinusitis. The presence of neutropenia, aplastic anemia, and living transplant were also associated with medically recalcitrant CRS requiring ESS. Conclusion Our predictive model identifies with high accuracy the patients who may be at risk of developing recalcitrant CRS in the organ transplant population.

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“…However, comprehensive preoperative anesthetic management in these parturients must evaluate essential considerations. The most important consideration is immunosuppressive therapy, its complications, especially hematological effects, its interaction with anesthetic drugs, and the potential risk of infection [11].…”

Section: Immunosuppressive Therapymentioning

confidence: 99%

Anesthetic Considerations for Cesarean Delivery After Uterine Transplant

Shehata¹,

Barsoumv²,

Elhass³

et al. 2021

Cureus

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Infertility has many etiologies and can have devastating consequences for young couples attempting to bring children into the world. Uterine factor for infertility is related to either uterine agenesis (Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome), unexpected hysterectomy, or presence of a nonfunctioning uterus. In this review, a patient with MRKH syndrome underwent donor uterus transplantation at the Cleveland Clinic, conceived, and delivered the first healthy baby in the United States and the second worldwide. Additionally, we review the pertinent literature on anesthesia problems. Donor-related uterine transplant is a recent medical innovation requiring multidisciplinary expertise. In patients who deliver successfully, according to the current literature, the transplanted uterus can be used for one more pregnancy only if the mother so desires, otherwise cesarean hysterectomy (C-Hyst) should be performed. In the observed case, C-Hyst was performed because the patient developed placenta accreta and the couple desired no further pregnancy. In summary, with our limited data, careful management of these patients is required to ensure the best outcome for the mother and the newborn fetus.

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Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery

Cited by 14 publications

References 64 publications

Evaluation of spinal instrumentation following organ transplantation: A retrospective cohort study

Evaluation of spinal instrumentation following organ transplantation: A retrospective cohort study

Risk Factors for Recalcitrant Chronic Rhinosinusitis in Organ Transplant Recipients

Anesthetic Considerations for Cesarean Delivery After Uterine Transplant

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