Intensive therapy after solid organ transplantation

Abstract

Transplantation medicine is an interdisciplinary task and the priority objective is a fast recovery to patient independence. After kidney transplantation the crucial aims are monitoring of transplant perfusion, maintainance of an adequate volume status and avoidance of nephrotoxic medications. Transplantation for patients with advanced chronic liver failure has become more common since the implementation of the model of end stage liver disease (MELD) allocation system which is associated with more complicated proceedings. The essentials of critical care after liver transplantation are monitoring of transplant function, diagnosis of perfusion or biliary tract problems, specific substitution of coagulation factors and hemodynamic optimation due to avoidance of hepatic congestion. Many patients listed for heart transplantation need preoperative intensive care due to impaired heart function. Postoperatively a specific cardiac support with pulmonary arterial dilatators and inotropics is usually necessary. Lung transplantation aims at an improvement of patient quality of life. Postoperative critical care should provide a limitation of the pulmonary arterial pressure, avoidance of volume overload and rapid weaning from the respirator.

Akzidentelle Fixierung eines Pulmonalarterienkatheters während einer Herztransplantation

“…Die Herztransplantation zählt zu den Eingriffen, bei denen der Einsatz des PAK indiziert ist, da die isolierte Rechtsherzinsuffizienz die häufigste Ursache für ein frühes Transplantatversagen darstellt [ 7 ].…”

“…B. über die Erfassung des pulmonalkapillären Verschlussdrucks als Parameter für die linksventrikuläre Vorlast bzw. die kontinuierliche Berechnung der rechtsventrikulären Ejektionsfraktion bei Verwendung von modernen Thermodilutionskathetern) [ 3 , 7 ].…”