The Transplant Operation

McCormack, Lucas; Selzner, Markus; Clavien, Pierre‐Alain

doi:10.1002/9780470751541.ch14

Cited by 15 publications

(18 citation statements)

References 28 publications

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“…All patients were transplanted without veno-venous bypass, as described by McCormack et al [22]. Patient records were analysed in respect to ASA class, operating time, estimated intraoperative blood loss, transfusion of RBC, FFP or platelets intraoperatively and the application of Fibrinogen.…”

Section: Methodsmentioning

confidence: 99%

The relationship between preoperative creatinine clearance and outcomes for patients undergoing liver transplantation: a retrospective observational study

et al. 2013

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BackgroundRenal failure with following continuous renal replacement therapy is a major clinical problem in liver transplant recipients, with reported incidences of 3% to 20%. Little is known about the significance of postoperative acute renal failure or acute-on-chronic renal failure to postoperative outcome in liver transplant recipients.MethodsIn this post hoc analysis we compared the mortality rates of 135 consecutive liver transplant recipients over 6 years in our center subject to their renal baseline conditions and postoperative RRT. We classified the patients into 4 groups, according to their preoperative calculated Cockcroft formula and the incidence of postoperative renal replacement therapy. Data then were analyzed in regard to mortality rates and in addition to pre- and peritransplant risk factors.ResultsThere was a significant difference in ICU mortality (p=.008), hospital mortality (p=.002) and cumulative survival (p<.0001) between the groups. The highest mortality rate occurred in the group with RRT and normal baseline kidney function (20% ICU mortality, 26.6% hospital mortality and 50% cumulative 1-year mortality, respectively). The hazard ratio in this group was 9.6 (CI 3.2-28.6, p=.0001).ConclusionThis study shows that in liver transplant recipient’s acute renal failure with postoperative RRT is associated with mortality and the mortality rate is higher than in patients with acute-on-chronic renal failure and postoperative renal replacement therapy.

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Section: Methodsmentioning

confidence: 99%

The relationship between preoperative creatinine clearance and outcomes for patients undergoing liver transplantation: a retrospective observational study

et al. 2013

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“…Organ procurement was performed as described elsewhere with aortic and portal perfusion using University of Wisconsin preservation solution (Viaspan™; DuPont Pharma, Wilmington, DE, USA) 15 . In agreement with others, 13,16–18 the following expanded criteria for donors were identified: cardiac arrest for >15 min or prolonged hypotensive episodes of <60 mmHg for >1 h; donor age >55 years, positive hepatitis B virus (HBV) infection; high vasopressor drug requirement (dopamine dose >10 µg/kg/min or any doses of other amines); hypernatraemia >155 mEq/l; prolonged intensive care unit (ICU) stay (≥5 days with mechanic ventilation); nosocomial infection (identified by positive blood cultures or pneumonia); elevated liver transaminases (AST >170 IU/l or ALT [alanine aminotransferase] >140 IU/l), and prolonged cold ischaemia time (>12 h).…”

Section: Methodsmentioning

confidence: 99%

“…Each LT recipient signed written informed consent before surgery. All transplants were performed without veno–venous bypass, as previously described 15 . The following recipient data were collected: age; underlying liver disease; MELD score; BMI; recipient status on the waiting list (elective, emergency); time on the waiting list; transfusion requirements, and operative time.…”

Section: Methodsmentioning

confidence: 99%

Rescue policy for discarded liver grafts: a single-centre experience of transplanting livers ‘that nobody wants’

McCormack

Quiñonez

Ríos³

et al. 2010

HPB

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“…We performed organ procurement with aortic and portal perfusion as described elsewhere 15. Collected donor data included donor age, graft cold ischemia time, and graft rewarming time.…”

Section: Methodsmentioning

confidence: 99%

“…OLT was performed by the classical technique without venovenous bypass, as previously described 15. Biliodigestive anastomosis was performed in 1 of 35 nondrained cases (3%) and in 7 of 70 drained cases (10%).…”

Section: Methodsmentioning

confidence: 99%

Abdominal drains in liver transplantation: Useful tool or useless dogma? A matched case-control study

Rougemont¹,

Dutkowski²,

Weber³

et al. 2009

Liver Transpl

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On the basis of the growing evidence from randomized trials that routine prophylactic drainage is unnecessary in liver surgery or even harmful in chronic liver disease, we challenged the concept of prophylactic drainage in orthotopic liver transplantation (OLT). Since September 2006, we omitted drains in every patient who underwent OLT, regardless of the procedure. Thirty-five cadaveric OLTs were performed during a 12-month period. These patients were matched 1:2 with 70 patients who had prophylactic drainage after OLT according to donor/recipient age, recipient gender, recipient body mass index, and Model for End-Stage Liver Disease (MELD) score. Endpoints were postoperative morbidity, in-hospital mortality, intensive care unit (ICU), and hospital stay. Complications were graded according to a therapy-oriented classification (grades I-V). Both groups (no drainage, n ϭ 35; drainage, n ϭ 70) were comparable in terms of median donor age (47.5 versus 51.0 years), recipient age (50.6 versus 52.0 years), MELD score (18 versus 14), and body mass index (25.3 versus 26 kg/m 2 ). Because of the increasing shortage of organs, more marginal grafts were used in the recent period (ie, no-drainage group): 49% (17/35) versus 27% (19/70; P ϭ 0.04). Major complications were not different between groups: grade 3a (endoscopic/radiological intervention) in 20% (7/35) versus 16% (11/70; not significant), grade 3b (surgical intervention) in 23% (8/35) versus 17% (12/70; not significant), grade 4a (ICU therapy, intermittent hemodialysis) in 34% (12/35) versus 21% (15/70; not significant), grade 4b (multiorgan failure) in 14% (5/35) versus 10% (7/70; not significant), and grade 5 (death) in 6% (2/35) versus 7% (5/70; not significant). This matched case study challenges the dogma of prophylactic drainage after OLT. A no-drain strategy provided no disadvantages despite increased use of extended criteria donors in the no-drainage group. Prophylactic drainage appears unnecessary on a routine basis. Liver Transpl 15:96-101, 2009.

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The Transplant Operation

Cited by 15 publications

References 28 publications

The relationship between preoperative creatinine clearance and outcomes for patients undergoing liver transplantation: a retrospective observational study

The relationship between preoperative creatinine clearance and outcomes for patients undergoing liver transplantation: a retrospective observational study

Rescue policy for discarded liver grafts: a single-centre experience of transplanting livers ‘that nobody wants’

Abdominal drains in liver transplantation: Useful tool or useless dogma? A matched case-control study

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