Abdominal Organ Transplantation: Noteworthy Literature in 2021

Abstract

This review highlights noteworthy literature pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. In 2021, we identified noteworthy papers from over 1,200 peer-reviewed publications on pancreatic transplantation, over 1,400 on intestinal transplantation, and over 9,000 on kidney transplantation. The liver transplantation section focuses on clinical trials and systematic reviews and meta-analyses published in 2021 and features 20 selected papers. COVID-19 and abdominal organ transplantation are featured in an independent section.

2021––Forging Ahead Into the Endemic While Struggling Against the New Challenges Facing Health Care Providers

“…6 The importance of central venous access in intestinal transplantation cannot be overstated—the authors review an article that describes the use of non-conventional vascular access (NCVA) for this patient population as a way to ensure ongoing venous access for long-term parenteral nutrition. 6…”

“…They point out that the utility of these risk indices may not be as useful in this particular patient population and the presence of certain risk factors including prior CVD history, diabetic nephropathy, age, duration of dialysis, hypoalbuminemia, proteinuria, and prior angina may indicate higher risk for peri-operative MACE. 6 However, despite these risk factors for increased risk of perioperative cardiac events, an ongoing trial performed a post hoc analysis that found no difference in mortality or non-fatal MI in patients who received revascularization for stable ischemic heart disease with inducible ischemia vs medical therapy alone. 6 The authors also report on a study evaluating pre-operative mean arterial pressure (MAP) and its relation to delayed graft function (DGF); unsurprisingly, patients with pre-operative MAP <80 were more likely to have DGF.…”

“…6 However, despite these risk factors for increased risk of perioperative cardiac events, an ongoing trial performed a post hoc analysis that found no difference in mortality or non-fatal MI in patients who received revascularization for stable ischemic heart disease with inducible ischemia vs medical therapy alone. 6 The authors also report on a study evaluating pre-operative mean arterial pressure (MAP) and its relation to delayed graft function (DGF); unsurprisingly, patients with pre-operative MAP <80 were more likely to have DGF. 6 Similarly, recipients with BMI >30 were more likely to have DGF and graft failure although patient survival was not affected by BMI.…”

“…6 A meta-analysis identified modifiable risk factors for the development of AKI after LT; the authors identified several pre-operative conditions and donor factors associated with AKI in addition to intraoperative risk factors (intraoperative hypotension, use of vasopressors, major bleeding, large RBC transfusion volume ,and post-reperfusion syndrome). 6 The use of terlipressin for type 1 hepatorenal syndrome (HRS) is common practice in many other countries. A phase 3 trial was recently completed evaluating the efficacy and safety of terlipressin in the United States, the authors found that it was more effective than placebo in improving renal function but was associated with a higher incidence of some adverse events (including respiratory failure).…”

“…A phase 3 trial was recently completed evaluating the efficacy and safety of terlipressin in the United States, the authors found that it was more effective than placebo in improving renal function but was associated with a higher incidence of some adverse events (including respiratory failure). 6 A recent study evaluated the utility of transcutaneous near-infrared spectroscopy (NIRS) for its ability to identify organs that may have impending vascular complications; it was shown that decreased oxygenation visible on NIRS pre-empted the identification of vascular complications. 6 The innovations in machine perfusion have yielded some of the most exciting research in liver transplantation, the authors reviewed recent studies evaluating the utility of hypothermic oxygenated machine perfusion (HOPE) for DCD grafts; two studies demonstrated reduction in early allograft dysfunction (EAD) and improved outcomes in DCD grafts that underwent HOPE when compared to similar grafts that were exposed to static cold storage.…”