Postreperfusion hyperkalemia in liver transplantation using donation after cardiac death grafts with pathological changes

Zhang, Wenjin; Xia, Weiliang; Pan, Hong; Zheng, Shusen

doi:10.1016/s1499-3872(16)60116-9

Cited by 18 publications

(28 citation statements)

References 20 publications

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“…The intraoperative concern for anesthesiologists and surgeons with DCD grafts is believed to be secondary to warm ischemia time during the procurement phase. Additional warm ischemia time during DCD liver graft procurement can potentially lead to an increased production of acidic, potassium‐rich substances that can be released into the systemic circulation during the reperfusion phase, thus leading to potentially catastrophic cardiovascular complications in the immediate postreperfusion period . Previous studies have investigated the effects of intraoperative events in both DBD and living donor LT; however, literature on intraoperative events with DCD LT is lacking.…”

Section: Discussionmentioning

confidence: 99%

“…catastrophic cardiovascular complications in the immediate postreperfusion period. (6) Previous studies have investigated the effects of intraoperative events in both DBD and living donor LT; however, literature on intraoperative events with DCD LT is lacking. A previously published study with a smaller number of DCD patients (n = 74) showed similar PRBC and FFP transfusions in the postreperfusion period between DCD and DBD liver graft recipients.…”

Section: Discussionmentioning

confidence: 99%

“…Donor steatosis was measured as macrosteatosis only. Steatosis grading has been previously published by our group . Intraoperative data collected included incidence of arrhythmia requiring cardiopulmonary resuscitation, incidence of PRS, and hyperkalemia.…”

Section: Methodsmentioning

confidence: 99%

“…Steatosis grading has been previously published by our group. (6) Intraoperative data collected included incidence of arrhythmia requiring cardiopulmonary resuscitation, incidence of PRS, and hyperkalemia. PRS was defined as bradycardia, hypotension persisting 10 minutes after reperfusion, and an increase in central venous pressures and pulmonary artery pressures.…”

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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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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“…The second of these studies included 14/131 patients with macrosteatosis > 20%. 30 That study demonstrated that macrosteatosis in the DCD graft liver was an independent risk factor of developing hyperkalemia and postreperfusion syndrome in the recipients.…”

Section: Discussionmentioning

confidence: 94%

Perioperative and long-term outcomes of utilizing donation after circulatory death liver grafts with macrosteatosis: A multicenter analysis

Croome

Mathur

Mao

et al. 2020

American Journal of Transplantation

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Background Given the potentially additive risk from using donor livers that are both steatotic and from a donation after circulatory death (DCD) donor, there is a paucity of data on the outcome of DCD liver transplantation (LT) utilizing livers with macrosteatosis. Methods All DCD LT performed at Mayo Clinic‐Florida, Mayo Clinic‐Arizona, and Mayo Clinic‐Rochester from 1999 to 2019 were included (N = 714). Recipients of DCD LT were divided into 3 groups: those with moderate macrosteatosis (30%‐60%), mild macrosteatosis (5%‐30%), and no steatosis (<5%). Results Patients with moderate macrosteatosis had a higher rate of postreperfusion syndrome (PRS; 53.9% vs 26.2%; P = .002), postreperfusion cardiac arrest (7.7% vs 0.3%; P < .001), primary nonfunction (PNF; 7.7% vs 1.0%; P = .003), early allograft dysfunction (EAD; 70.8% vs 45.6% and 8.3%; P = .02), and acute kidney injury (AKI; 39.1% vs 19.4%; P = .02) than patients with no steatosis. No difference in any of the perioperative complications was seen between the mild macrosteatosis and the no steatosis groups except for the rate of EAD (56.8% vs 45.6%; P = .04). No difference in ischemic cholangiopathy (IC), vascular thrombosis/stenosis or graft, and patient survival was seen between the 3 groups. Conclusion DCD donors with mild macrosteatosis < 30% can be utilized with no increase in perioperative complications and similar patient and graft survival compared to DCD donors with no steatosis. When utilizing DCD donors with moderate macrosteatosis higher rates of PRS, PNF, postreperfusion cardiac arrest, EAD, and AKI should be anticipated.

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Non-biliary Complications Associated with Liver Grafts from Donation After Circulatory Death Donors

Wilson

Goldberg

Abt

2020

Donation After Circulatory Death (DCD) Liver Transplantation

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Postreperfusion hyperkalemia in liver transplantation using donation after cardiac death grafts with pathological changes

Cited by 18 publications

References 20 publications

Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

Intraoperative Events in Liver Transplantation Using Donation After Circulatory Death Donors

Perioperative and long-term outcomes of utilizing donation after circulatory death liver grafts with macrosteatosis: A multicenter analysis

Non-biliary Complications Associated with Liver Grafts from Donation After Circulatory Death Donors

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