Survival from massive intraoperative pulmonary thromboembolism during orthotopic liver transplantation

Manji, Mavji; Isaac, J.; Bion, Julian

doi:10.1093/bja/80.5.685

Cited by 42 publications

(44 citation statements)

References 6 publications

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“…1,15,16 It is believed that intraoperative ICTs during OLT are greatly underdiagnosed and underreported. 9 The need for TEE monitoring is an obstacle for the accurate diagnosis of intraoperative ICTs (particularly those without significant hemodynamic changes). In this study, using prospectively collected data, we demonstrated that the incidence of ICTs in patients who were monitored by TEE during OLT was 1.9%.…”

Section: Discussionmentioning

confidence: 99%

“…4,7,9,10,12,13,17,18 Others are inherent to the OLT procedure: excessive activation of the coagulation system, venous stasis during clamping of the portal vein and inferior vena cava, and release of activators from the liver graft. 6,7,9 In addition, other conditions such as heparin-induced thrombocytopenia, factor V Leiden, and antithrombin deficiency can contribute to thrombosis and possibly ICTs during OLT. Finally, intraoperative management may play an important role: PA catheter placement; the administration of antifibrinolytics, anti-hepatitis B immunoglobulin, and blood products; and the intraoperative utilization of continuous venovenous filtration.…”

Section: Discussionmentioning

confidence: 99%

“…The thromboemboli in these cases are usually described as large, massive, severe, or fatal; these terms refer to the clot size, the impact on hemodynamics, or the patient outcomes (the term massive is used throughout this report). [3][4][5][6][7][8][9][10][11][12][13][14] The diagnosis of massive thromboemboli can be made on the basis of a typical clinical presentation with or without transesophageal echocardiography (TEE) evidence. Several strategies have been reported for the management of massive thromboemboli during OLT.…”

mentioning

confidence: 99%

“…6,[9][10]13 Despite aggressive pharmaceutical or surgical interventions, the overall mortality rate for patients with thromboemboli during OLT remains high, and a majority of the patients die intraoperatively.…”

mentioning

confidence: 99%

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Incidental intracardiac thromboemboli during liver transplantation: Incidence, risk factors, and management

Xia

Nourmand

et al. 2010

Liver Transpl

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Even though numerous cases of massive thromboemboli have been reported in the literature, intracardiac thromboemboli (ICTs) incidentally found during orthotopic liver transplantation (OLT) have not been examined. In this study, we retrospectively examined the incidence, risk factors, and management of incidental ICTs during OLT. After institutional review board approval, adult patients who underwent OLT between January 2004 and December 2008 at our center were reviewed. ICTs were identified and confirmed by the examination of OLT datasheets, anesthesia records, and recorded transesophageal echocardiography (TEE) clips. The clinical presentation, management, and outcomes of the patients with ICTs were reviewed. Risk factors were analyzed by multivariate logistic regression. During the study period, 426 of the 936 adult OLT patients (45.5%) underwent intraoperative TEE monitoring. Incidental ICTs were identified in 8 of these 426 patients (1.9%). Two ICTs occurred before reperfusion, and 6 ICTs occurred after reperfusion. The treatment was at the discretion of the treating physicians; however, none of the patients received an anticoagulant or thrombolytics. Multivariate analysis identified 2 independent risk factors for intraoperative incidental ICTs: the presence of symptomatic or surgically treated portal hypertension (a history of gastrointestinal bleeding, a transjugular intrahepatic portosystemic shunt procedure, or portocaval shunt surgery) before OLT and intraoperative hemodialysis (odds ratios of 4.05 and 7.29, respectively; P < 0.05 for both). In conclusion, incidental ICTs during OLT occurred at a rate of 1.9% and were associated with several preoperative and intraoperative risk factors. The use of TEE allows early identification, which may be important. Our management for incidental ICTs is described; however, no conclusions can be made about the optimal therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Incidental intracardiac thromboemboli during liver transplantation: Incidence, risk factors, and management

Xia

Nourmand

et al. 2010

Liver Transpl

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“…Thromboelastograph helps assessing both cellular and humoral components of whole blood coagulation and fibrinolysis; and also the effects of antifibrinolytic therapy, cryoprecipitate, fresh frozen plasma, platelet and protamin as treatment strategies. However, there have been some case reports of thromboembolic complications in patients treated with antifibrinolytic agents (Manji et al, 1998;Sopher et al, 1997;O'Connor et al, 2000;Gologorsky et al;Ramsay et al, 2004;Ellenberger et al, 2006). A systematic review and meta-analysis of the safety of antifibrinolytic drugs has not shown any relationship with thrombosis in liver transplantation (Molenaar et al 2007).…”

Section: The Neohepatic Phasementioning

confidence: 99%

Anesthesia in Liver Transplantation

Kanbak¹,

Karagöz²,

Üzümcügil³

2012

Liver Transplantation - Basic Issues

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The prophylactic use of tranexamic acid and aprotinin in orthotopic liver transplantation: A comparative study

et al. 2004

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The efficacy of tranexamic acid (TA) and aprotinin (AP) in reducing blood product requirements in orthotopic liver transplantation (OLT) was compared in a prospective, randomized and double-blind study. One hundred and twenty seven consecutive patients undergoing OLT were enrolled; TA was administered to 64 OLT patients at a dose of 10mg /kg/h and aprotinin was administered to 63 OLT patients at a loading dose of 2x10 6 KIU followed by an infusion of 500,000 KIU/h. The portocaval shunt could not be performed in 14 OLT patients in the TA group and in 13 OLT patients in the AP group. However, all OLT patients that received either drug were included in the analysis. Perioperative management was standardized. Hemogram, coagulation tests, and blood product requirements were recorded during OLT and during the first 24 hours. No differences in diagnosis, Child score, preoperative coagulation tests, and intraoperative data were found between groups. No significant differences were observed in hemogram and intraoperative coagulation tests with the exception of activated partial thromboplastin time (aPTT). Similarly, there were no intergroup differences in transfusion requirements. Thromboembolic events, reoperations and mortality were similar in both groups. In conclusion, administration of regular doses of TA and AP during OLT did not result in large differences between the two groups. (Liver Transpl 2004; 10:279 -284.)

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Survival from massive intraoperative pulmonary thromboembolism during orthotopic liver transplantation

Cited by 42 publications

References 6 publications

Incidental intracardiac thromboemboli during liver transplantation: Incidence, risk factors, and management

Incidental intracardiac thromboemboli during liver transplantation: Incidence, risk factors, and management

Anesthesia in Liver Transplantation

The prophylactic use of tranexamic acid and aprotinin in orthotopic liver transplantation: A comparative study

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