Avoiding Stay in the Intensive Care Unit After Liver Transplantation: A Score to Assign Location of Care

Bulatao, Ilynn G.; Heckman, Michael G.; Rawal, Bhupendra; Aniskevich, Stephen; Shine, Timothy S.J.; Keaveny, Andrew P.; Perry, Dana K.; Canabal, Juan M.; Willingham, Darrin L.; Taner, C. Burcin

doi:10.1111/ajt.12796

Cited by 48 publications

(39 citation statements)

References 17 publications

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“…Select postoperative outcomes were also collected including eligibility to follow the fast‐track protocol (bypassing ICU care), need for postoperative renal replacement therapy (RRT), reoperation within the first 30 days after transplant, primary nonfunction (PNF), early allograft dysfunction (EAD), and biliary and vascular complications. Fast‐track protocol from our institution has previously been described in detail . Briefly, it is defined as complete avoidance of the ICU care following the operation, with the patient being directly transferred to the postanesthesia care unit with subsequent admission to the surgical/transplant ward.…”

Section: Methodsmentioning

confidence: 99%

“…The use of a subclinical 500 mg or 1 g dose of antifibrinolytic therapy (which at our institution is aminocaproic acid) was done so at the discretion of the anesthesiologist based on their assessment of the testing mentioned previously. At the conclusion of the case, the patient would be considered to be a fast‐track candidate on the basis of previously established criteria for our institution . If not a fast‐track candidate, the patient would be transferred to the ICU.…”

Section: Methodsmentioning

confidence: 99%

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Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

et al. 2019

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Liver grafts from donation after circulatory death (DCD) are a source of organs to decrease wait‐list mortality. While there have been lower rates of graft loss, there are concerns of an increased incidence of intraoperative events in recipients of DCD grafts. We aim to look at the incidence of intraoperative events between recipients of livers from DCD and donation after brain death (DBD) donors. We collected data for 235 DCD liver recipients between 2006 and 2017. We performed a 1:1 propensity match between these patients and patients with DBD donors. Variables included recipient age, liver disease etiology, biological Model for End‐Stage Liver Disease (MELD) score, allocation MELD score, diagnosis of hepatocellular carcinoma, and year of transplantation. DCD and DBD groups had no significant differences in incidence of postreperfusion syndrome (P = 0.75), arrhythmia requiring cardiopulmonary resuscitation (P = 0.66), and treatments for hyperkalemia (P = 0.84). In the DCD group, there was a significant increase in amount of total intraoperative and postreperfusion blood products (with exception of postreperfusion packed red blood cells) utilized (P < 0.05 for all products), significant differences in postreperfusion thromboelastography parameters, as well as inotropes and vasopressors used (P < 0.05 for all infusions). There was no difference in patient (P = 0.49) and graft survival (P = 0.10) at 1, 3, and 5 years. In conclusion, DCD grafts compared with a cohort of DBD grafts have a similar low incidence of major intraoperative events, but increased incidence of transient vasopressor/inotropic usage and increased blood transfusion requirements. This does not result in differences in longterm outcomes. While centers should continue to look at DCD liver donors, they should be cognizant regarding intraoperative care to prevent adverse outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

et al. 2019

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“…Orthotopic liver transplant remains a formidable surgical operation, and PRBC transfusion volume is a known independent predictor of postoperative outcomes. 2,5,9,[10][11][12]14,16,22 Modern efforts to minimize PRBC transfusions during OLT may reduce risks to the patient, such as transfusion-related lung injury, immunomodulation, and iatrogenic infection. An LVT risk index tool could result in multiple benefits, including improving patient outcomes, containing transplant costs, and conserving valuable blood bank time and resources.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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Objectives: The primary aim of this study was to determine whether specific preoperative clinical characteristics were associated with low-volume transfusion in liver transplant recipients. Low-volume transfusion was defined as transfusion of < 2100 mL of packed red blood cells intraoperatively during liver transplant. The ability to accurately predict lowvolume transfusion could increase patient safety, decrease complications associated with transfusion, improve blood management, and decrease transplant case cost. Materials and Methods: Data were retrieved by retrospective chart review of 266 patients who received a liver transplant at the Mayo Clinic (Jacksonville, FL, USA). The primary outcome was lowvolume transfusion. Associations of preoperative information with low-volume transfusion were explored using single-variable and multivariable logistic regression models; missing data were imputed with the sample median for continuous data and the most frequent category for categorical variables. Results: Low-volume transfusion occurred in 23% of first-time liver transplant recipients (62/266 patients; 95% confidence interval, 18%-29%). History of hepatitis C virus infection (P = .048), history of hepatocellular carcinoma (P = .050), short cold ischemia time (P = .006), and low international normalized ratio (P = .002) were independently associated with low-volume transfusion during liver transplant in a multivariable logistic regression model. Conclusions: Multiple studies have shown increased morbidity and mortality after orthotopic liver transplant when more than 6 U of packed red blood cells are administered within 24 hours of surgical incision. A method to identify low-volume transfusion candidates could help predict patient outcomes, decrease blood handling, and reduce costs. If patients with low-volume transfusion could be identified, fewer blood products would need to be prepared in advance. Although elevated preoperative coagulation parameters decrease the probability of low-volume transfusion, a definitive profile of a low-volume transfusion liver transplant recipient was not established.

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“…Essential components of such practice include integration of anesthesiology, transplant surgery, hepatology, and nursing services, as well as 24‐hour availability of a postanesthesia care unit. Successful prediction of fast‐tracking depends on recipients' pre‐LT condition, intraoperative events, and the transplant team's experience in predicting post‐LT problems . This practice, when judiciously performed, has been shown to be safe without any deleterious effect on patient or graft survival or complication rates .…”

Section: Immediate Care Of the Lt Recipientmentioning

confidence: 99%

“…Successful prediction of fast‐tracking depends on recipients' pre‐LT condition, intraoperative events, and the transplant team's experience in predicting post‐LT problems . This practice, when judiciously performed, has been shown to be safe without any deleterious effect on patient or graft survival or complication rates . Patients who avoid ICU stay, as long as it is done safely, consume fewer resources.…”

Section: Immediate Care Of the Lt Recipientmentioning

confidence: 99%