Living-donor liver transplantation following cardiopulmonary bypass

Abstract

Rationale:Liver transplantation is an increasingly common treatment for patients with liver cirrhosis or hepatocellular carcinoma. Liver transplantation in patients with heart disease can pose a significant challenge to the transplant teams.Patient concerns:A 46-year-old woman was diagnosed with hepatitis B virus-related hepatocellular carcinoma 3 years ago and had received 3 times transarterial chemoembolization.Diagnoses:The patient was diagnosed as end-stage liver disease due to hepatocellular carcinoma and was scheduled to undergo living-donor liver transplantation. The preoperative echocardiogram revealed mass in the right atrium and the inferior vena cava.Interventions:The patient underwent mass removal under cardiopulmonary bypass followed by liver transplantation.Outcomes:A month later, she was discharged without any complications.Lessons:There have only been a few reported cases of anesthetic liver transplantation after a cardiopulmonary bypass. The successful experience described in this case report suggests that some patients may be eligible to undergo a liver transplantation after a cardiopulmonary bypass.

Thromboembolism after cardiac surgery in a patient with cancer-related thrombosis and severe thrombocytopenia

“…If lower doses of heparin are used, thrombin production can be increased, which can reduce the hemostatic function of platelets, leading to increased bleeding risk after CPB. [ 6 ] In this case, 150 mg (15,000 U) of heparin was used before CPB, and ACT of 526 seconds was confirmed after 15 minutes. During CPB, the maximal ACT was 873 and 109 seconds after heparin reversal with protamine.…”

“…The initial pre-CPB dose of heparin for anticoagulation is recommended at 300 U/kg and prevents fibrin monomer appearance during CPB when the ACT is above 400 seconds. If lower doses of heparin are used, thrombin production can be increased, which can reduce the hemostatic function of platelets, leading to increased bleeding risk after CPB [6] . In this case, 150 mg (15,000 U) of heparin was used before CPB, and ACT of 526 seconds was confirmed after 15 minutes.…”

“…Hypothermia, hemodilution, and hypoperfusion during CPB also can be responsible for increased bleeding risk after surgery. [ 6 ] In general, heparin is used before cannulation of CPB. In patients undergoing heart surgery, heparin-induced thrombocytopenia (HIT) occurs in 1 to 3% due to formation of antibodies against the heparin and platelet factor 4 antibody complex.…”

“…CPB is associated with platelet and coagulation defects, inflammation, and increased fibrinolysis and exacerbates hemostasis by releasing numerous vasoactive substances and cytotoxic chemicals that affect coagulation, vascular resistance, vascular permeability, fluid balance, and major organ function. Hypothermia, hemodilution, and hypoperfusion during CPB also can be responsible for increased bleeding risk after surgery [6] . In general, heparin is used before cannulation of CPB.…”