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Burtenshaw AJ, Isaac JL. The role of trans-oesophageal echocardiography for perioperative cardiovascular monitoring during orthotopic liver transplantation. Liver Transpl 2006; 12:1577-1583. After a detailed review of the rationale for an effective cardiovascular monitoring tool during the OLT procedure, this article appraises the value of TOE. The potential advantages and complications of the technique are compared with the traditional pulmonary artery catheter.
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Xia VW, Ghobrial RM, Du B, et al. Predictors of hyperkalemia in the prereperfusion, early postreperfusion, and late postreperfusion periods during adult liver transplantation. Anesth Analg 2007; 105:780-785. This retrospective study of a large cohort of adult cases (including cardiac death and living donor OLT) helps to identify patients in whom a preventive therapy of hyperkalemia should be initiated. Models including baseline hyperkalemia, intraoperative variables and donor characteristics are developed for the prediction of hyperkalemia during the different stages of the procedure. A rather unexpected variable is the use of VVBP.
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Xia VW, Ghobrial RM, Du B, et al. Predictors of hyperkalemia in the prereperfusion, early postreperfusion, and late postreperfusion periods during adult liver transplantation. Anesth Analg 2007; 105:780-785. This retrospective study of a large cohort of adult cases (including cardiac death and living donor OLT) helps to identify patients in whom a preventive therapy of hyperkalemia should be initiated. Models including baseline hyperkalemia, intraoperative variables and donor characteristics are developed for the prediction of hyperkalemia during the different stages of the procedure. A rather unexpected variable is the use of VVBP.
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Xia VW, Du B, Tran A, et al. Intraoperative hypokalemia in pediatric liver transplantation: incidence and risk factors. Anesth Analg 2006; 103:587-593. Unlike adults, pediatric recipients are prone to intraoperative hypokalemia during OLT, as shown in this series of 268 cases. The reasons for this difference are unclear, but some risk factors can be identified.
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Xia VW, Du B, Tran A, et al. Intraoperative hypokalemia in pediatric liver transplantation: incidence and risk factors. Anesth Analg 2006; 103:587-593. Unlike adults, pediatric recipients are prone to intraoperative hypokalemia during OLT, as shown in this series of 268 cases. The reasons for this difference are unclear, but some risk factors can be identified.
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64
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66
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68
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McCluskey SA, Karkouti K, Wijeysundera DN, et al. Derivation of a risk index for the prediction of massive blood transfusion in liver transplantation. Liver Transpl 2006; 12:1584-1593.
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Xia VW, Du B, Braunfeld M, et al. Preoperative characteristics and intraoperative transfusion and vasopressor requirements in patients with low vs. high MELD scores. Liver Transpl 2006; 12:614-620.
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Massicotte L, Sassine MP, Lenis S, et al. Transfusion predictors in liver transplant. Anesth Analg 2004; 98:1245-1251.
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Coakley M, Reddy K, Mackie I, et al. Transfusion triggers in orthotopic liver transplantation: a comparison of the thromboelastometry analyzer, the thromboelastogram, and conventional coagulation tests. J Cardiothorac Vasc Anesth 2006; 20:548-553. This interesting paper shows that perioperative transfusion practices in liver transplantation are likely to differ according to the method of coagulation monitoring used. The greatest variability in fulfilling transfusion criteria between coagulation monitoring systems occurred for transfusion of fresh frozen plasma.
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Coakley M, Reddy K, Mackie I, et al. Transfusion triggers in orthotopic liver transplantation: a comparison of the thromboelastometry analyzer, the thromboelastogram, and conventional coagulation tests. J Cardiothorac Vasc Anesth 2006; 20:548-553. This interesting paper shows that perioperative transfusion practices in liver transplantation are likely to differ according to the method of coagulation monitoring used. The greatest variability in fulfilling transfusion criteria between coagulation monitoring systems occurred for transfusion of fresh frozen plasma.
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73
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Ramos E, Dalmau A, Sabate A, et al. Intraoperative red blood cell transfusion in liver transplantation: influence on patient outcome, prediction of requirements, and measures to reduce them. Liver Transpl 2003; 9:1320-1327.
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de Boer MT, Christensen MC, Asmussen M, et al. The impact of intraoperative transfusion of platelets and red blood cells on survival after liver transplantation. Anesth Analg 2008; 106:32-44. As earlier studies have shown, this retrospective study of 433 adult cases between 1989 and 2004 indicates that RBCs transfusions are an independent risk factor for survival following OLT. A remarkable point is the negative impact of platelet transfusion on survival shown by propensity-adjusted analysis. Transfusion of platelets and RBCs is highly dominant in predicting 1- year patient survival. Interestingly, the blood-sparing effect of antifibrinolytic therapy does not appear to have influenced survival in univariate analysis.
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de Boer MT, Christensen MC, Asmussen M, et al. The impact of intraoperative transfusion of platelets and red blood cells on survival after liver transplantation. Anesth Analg 2008; 106:32-44. As earlier studies have shown, this retrospective study of 433 adult cases between 1989 and 2004 indicates that RBCs transfusions are an independent risk factor for survival following OLT. A remarkable point is the negative impact of platelet transfusion on survival shown by propensity-adjusted analysis. Transfusion of platelets and RBCs is highly dominant in predicting 1- year patient survival. Interestingly, the blood-sparing effect of antifibrinolytic therapy does not appear to have influenced survival in univariate analysis.
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75
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Reyle-Hahn M, Rossaint R. Coagulation techniques are not important in directing blood product transfusion during liver transplantation. Liver Transpl Surg 1997; 3:659-663; discussion 663-655.
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Massicotte L, Lenis S, Thibeault L, et al. Effect of low central venous pressure and phlebotomy on blood product transfusion requirements during liver transplantations. Liver Transpl 2006; 12:117-123. The authors report that 79% of a series of almost 100 cases could be performed without the use for any blood products, provided the patient's CVP is kept low through restriction of replacement, elimination of all plasma transfusion, and eventually by using intra-operative phlebotomy. Blood salvage and low RBC transfusion trigger are also used. This strategy was apparently not damaging to renal function or to other vital systems. These data give points to arguments against aggressive and product use. They have been hotly debated, however, especially regarding the mean MELD scores at operation that seem lower than those at some other centers, and clearly need confirmation
-
Massicotte L, Lenis S, Thibeault L, et al. Effect of low central venous pressure and phlebotomy on blood product transfusion requirements during liver transplantations. Liver Transpl 2006; 12:117-123. The authors report that 79% of a series of almost 100 cases could be performed without the use for any blood products, provided the patient's CVP is kept low through restriction of volume replacement, elimination of all plasma transfusion, and eventually by using intra-operative phlebotomy. Blood salvage and low RBC transfusion trigger are also used. This strategy was apparently not damaging to renal function or to other vital systems. These data give points to arguments against aggressive volume and product use. They have been hotly debated, however, especially regarding the mean MELD scores at operation that seem lower than those at some other centers, and clearly need confirmation.
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77
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79
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Niemann CU, Behrends M, Quan D, et al. Recombinant factor VIIa reduces transfusion requirements in liver transplant patients with high MELD scores. Transfus Med 2006; 16:93-100.
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Warnaar N, Molenaar IQ, Colquhoun SD, et al. Intraoperative pulmonary embolism and intracardiac thrombosis complicating liver transplantation: a systematic review. J Thromb Haemost 2007; 6:297-302. The authors have identified 74 published OLT cases complicated by intraoperative pulmonary embolism and intracardiac thrombosis, and they have studied the clinical presentation, the outcome, and potential risk factors. None of the usual putative risk factors appeared to be universally present, suggesting a multifactorial pathogenesis. A valuable contribution to the knowledge of this dreadful complication.
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Mandell MS, Stoner TJ, Barnett R, et al. A multicenter evaluation of safety of early extubation in liver transplant recipients. Liver Transpl 2007; 13:1557-1563. This large and multiinstitutional study has gathered information on the frequency, type, severity, and risk factors of adverse outcomes following early extubation as well as on differences between seven institutions using the same criteria. Adverse events were uncommon, usually pulmonary or surgically related. Variables associated with adverse events were the number of units of blood transfused, the piggyback technique, and the use of VVBP, but this does not imply a causal link. Marked unexplained interinstitutional differences are noted.
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