Intra-operative cell salvage and sickle cell trait in liver transplantation: time to reconsider?

Loh, Pui San; Gilder, Fay; Klinck, John

doi:10.1111/tri.13268

Cited by 7 publications

(7 citation statements)

References 4 publications

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“…The optimal strategy for the management of patients with SCD and SCT undergoing cardiac surgery is not universally agreed upon . It is recognized that during CPB, many of the common precipitating risk factors for a sickling crisis present, and many were experienced by our patient including the use of cell salvage, which has traditionally been thought to be high risk, although this has recently been put into question . Unfortunately, it is not possible for us to identify individual factors that contributed to the outcome for this patient.…”

Section: Discussionmentioning

confidence: 96%

Catastrophic sickling crisis in patient undergoing cardiac transplantation with sickle cell trait

Ali

Besser

Goddard

et al. 2019

American Journal of Transplantation

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There is debate in the literature regarding management of patients with sickle cell trait (SCT) undergoing cardiac surgery, since it is recognized that cardiopulmonary bypass presents many precipitating risk factors for a sickling crisis. Despite this, many report successful outcomes without any modification to perioperative management. A 49‐year‐old woman with SCT (HbS 38%) with postpartum cardiomyopathy underwent cardiac transplantation. The patient was cooled to 34.0°C and retrograde cold blood cardioplegia was infused continuously. The cold ischemic time was 219 minutes and warm ischemic time 46 minutes. After weaning from bypass, she developed global cardiac dysfunction requiring veno‐arterial extracorporeal membrane oxygenation. The circuit suddenly stopped, requiring emergency reinstitution of bypass; the circuit had clotted. Transesophageal‐echocardiogram revealed thrombus within the left atrium and ventricle. There was no recovery of cardiac function and the patient developed multiorgan failure. At postmortem there was extensive myocardial infarction with evidence of widespread catastrophic intravascular red‐cell sickling. This case highlights the danger of complacency in patients with SCT, offering a learning opportunity for the cardiothoracic community to highlight the most serious complication that can occur in this group of patients. We have learned that SCT and cardiac surgery is not a benign combination.

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Section: Discussionmentioning

confidence: 96%

Catastrophic sickling crisis in patient undergoing cardiac transplantation with sickle cell trait

Ali

Besser

Goddard

et al. 2019

American Journal of Transplantation

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“…In practice, LT can be indicated in two settings [4]: acute liver failure mimicking fulminant hepatitis and end-stage chronic liver disease. Data regarding liver transplantation (LT) in patients with SCD are limited to mostly case reports (Table 1) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Because of the paucity of data available regarding the indications for LT and perioperative outcomes as well as the lack of long-term follow-up in most reported cases, the present study entailed a thorough analysis of a large single-center experience of LT in patients with SCD.…”

Section: Introductionmentioning

confidence: 99%

Liver transplantation in patients with sickle cell disease: possible but challenging—a cohort study

et al. 2020

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The liver is frequently affected in patients with sickle cell disease (SCD), but few reports have described liver transplantation (LT) in patients with SCD. We present a thorough analysis of the largest single-center series of LT in patients with SCD and the first systematic review. There were 21 patients with a median age of 37.6 years. LT was performed for acute liver failure related to the sickling process (57%) or electively for end-stage liver disease (43%). Prior to LT, 13 patients (62%) were in the intensive care unit and required mechanical ventilation (33%), vasopressor therapy (24%), renal replacement therapy (10%), or molecular adsorbent recirculating system therapy (19%). Post-LT morbidity and mortality were 95% and 33%, respectively. Patient survival at 1 and 5 years were 58.3% and 41.7%, respectively, in the urgent group and 88.9% and 77.8%, respectively, in the elective group. A total of 22 transplant patients with SCD are described in 20 articles in the literature. The 1-and 5-year patient survival rates for the 18 evaluable patients were 75% and 65%, respectively. LT improves survival in patients with SCD and acute liver failure or end-stage liver disease but is associated with high morbidity during the early postoperative course.

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“…15 Cell-salvaged blood can have a higher incidence of sickling 13 ; however, this process has been used successfully for liver transplantation in a SCT patient. 17 Sickling in salvaged blood possibly should be quantified routinely. The sickle cell index (SCI) is a rapid, simple, and widely available measurement of both reversible and irreversible sickle states by microscopic examination of blood smears.…”

Section: Discussionmentioning

confidence: 99%

Severe Hypoxia and Compartment Syndrome in a Patient With Sickle Cell Trait After Redo Aortic Valve Replacement: A Case Report and Review of the Literature

Moll

Fiza

Ward

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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Intra-operative cell salvage and sickle cell trait in liver transplantation: time to reconsider?

Cited by 7 publications

References 4 publications

Catastrophic sickling crisis in patient undergoing cardiac transplantation with sickle cell trait

Catastrophic sickling crisis in patient undergoing cardiac transplantation with sickle cell trait

Liver transplantation in patients with sickle cell disease: possible but challenging—a cohort study

Severe Hypoxia and Compartment Syndrome in a Patient With Sickle Cell Trait After Redo Aortic Valve Replacement: A Case Report and Review of the Literature

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