Anesthesia for Organ Transplantation

Scott, Victor L.; Wahl, Kerri M.; Soltys, Kyle; Belani, Kumar G.; Beebe, David S.; Davis, Peter J.

doi:10.1016/b978-0-323-06612-9.00028-6

Cited by 8 publications

(4 citation statements)

References 352 publications

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“…The definition of severe PRS [ 1 ] comprises a more serious form of PRS and vasoplegia and is more suitable for clinical use in DDLT, especially when a DCD or ECD donor liver is implanted. Fourth, we were not able to analyze the relationship between serum potassium concentration and severe PRS because the potassium concentration immediately after reperfusion was not routinely measured, and the temporarily elevated potassium level usually returns to normal in 1 to 2 min as a result of uptake by the new liver [ 34 ]. Further research will be needed to confirm whether a relationship exists between the change in serum potassium concentration and severe PRS.…”

Section: Discussionmentioning

confidence: 99%

Association Between Flushed Fluid Potassium Concentration and Severe Postreperfusion Syndrome in Deceased Donor Liver Transplantation

et al. 2017

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BackgroundsPredicting the occurrence of severe postreperfusion syndrome (PRS) is clinically challenging. We investigated whether the flushed fluid potassium concentration (FFK) was associated with severe PRS in deceased donor liver transplantation (DDLT).Material/MethodsForty adult DDLT recipients were enrolled in this retrospective study. Effluent solution samples were collected at the end of the portal vein flush, and the FFK was determined using a point-of-care blood gas analyzer. The risk factors associated with severe PRS and the clinical outcomes in 2 groups were compared.ResultsSevere PRS occurred in 22 out of 40 patients (55.0%). The FFK of the severe PRS group was significantly higher than that of the non-severe PRS group (median, 9.6 vs. 5.8, P<0.001). Other variables associated with severe PRS included the donor risk index (DRI), Child-Turcotte-Pugh score, donor type, donor warm ischemia time, and Model for End-stage Liver Disease score. The area under the receiver operator characteristic curve for the FFK was 0.982, and the best cut-off value of the FFK for predicting severe PRS was 6.75 mmol/L (100.0% sensitivity and 88.9% specificity). A significant positive correlation was observed between the FFK and DRI (R=0.714). Patients who experienced severe PRS had a higher early allograft dysfunction rate (63.6% vs. 22.2%, P=0.019) and a longer hospital stay (median, 33.0 vs. 24.0, P=0.034).ConclusionsBoth the severity of the recipient’s liver disease and the donor graft factors play an important role in the development of severe PRS in DDLT. An FFK of more than 6.75 mmol/L was associated with severe PRS after reperfusion.

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Section: Discussionmentioning

confidence: 99%

Association Between Flushed Fluid Potassium Concentration and Severe Postreperfusion Syndrome in Deceased Donor Liver Transplantation

et al. 2017

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“…Hyperkalemia in LT usually results from the transfusion of banked RBCs, which have a potassium concentration of 76 mmol/L after 35 days of cold storage [ 27 ]. This problem has been solved in our center through the use of a cell saver to remove potassium from the banked RBCs.…”

Section: Discussionmentioning

confidence: 99%

“…The results are in accordance with the changes in the serum potassium concentration after reperfusion. A transient 2- to 3-fold increase in the potassium level has been reported to occur immediately after reperfusion; the potassium level then returns to normal in 1 to 2 minutes due to uptake by the new liver [ 27 , 29 ]. The speed-control reperfusion technique avoids the sudden rise in the serum potassium level, thus preventing PRS and PRCA due to acute hyperkalemia.…”

Section: Discussionmentioning

confidence: 99%

Expanded Criteria Donor-Related Hyperkalemia and Postreperfusion Cardiac Arrest During Liver Transplantation: A Case Report and Literature Review

et al. 2018

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BackgroundLiver transplantation (LT) using extended criteria donor (ECD) grafts is frequently associated with a high flush fluid potassium concentration (FFK) and acute hyperkalemia after reperfusion, which puts patients at greater risk of postreperfusion cardiac arrest (PRCA).Case ReportHerein, we present a case with an extremely high FFK that was successfully pretreated to avoid the risk of PRCA. A 3-year-old boy with biliary atresia underwent LT from a 623-g donation after brain death liver graft with localized frostbite on the right lobe surface. The FFK was 18.8 mmol/L after flushing with 1000 mL of 5% albumin. To prevent PRCA due to acute hyperkalemia, further portal vein (PV) flush, retrograde reperfusion via the inferior vena cava, and antegrade reperfusion via the PV were adopted to remove the excessive potassium ions. Ultimately, the liver graft was reperfused when the perfused blood potassium concentration was 7.5 mmol/L without subsequent development of PRCA during the immediate reperfusion period. Nevertheless, the patient still experienced vasoplegic syndrome during the late reperfusion period.ConclusionsOur case illustrates that the FFK measurement is helpful for identifying ECD-related hyperkalemia and for providing advance warning of PRCA. Future investigations are warranted to confirm the relationship between high FFK and PRCA and to observe the effectiveness of other interventions to prevent PRCA due to ECD-related hyperkalemia.

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“…Child-Pugh (CP) scoring assesses severity of liver disease in terms of grade of hepatic encephalopathy, degree of ascites, serum albumin and bilirubin levels, and prothrombin time. Each variable is graded on a point system, with the total points used to assign a grade of A, B or C, in order of increasing severity; higher scores indicate poorer operative risk [ 8 ].…”

mentioning

confidence: 99%

Clinical Outcomes By Child-Pugh Class in Patients With Advanced Hepatocellular Carcinoma in a Community Oncology Setting

et al. 2023

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Aim: Many pivotal trials in advanced hepatocellular carcinoma (HCC) require participants to have Child-Pugh A disease. However, many patients in real-world practice are Child-Pugh B or C. This study examined treatment patterns and clinical outcomes in patients with advanced HCC treated with first-line systemic therapy. Materials & methods: In this retrospective study, patients with HCC treated with first-line systemic therapy (2010–2017) were identified from US Oncology Network records. Outcomes included overall survival and progression-free survival, by Child-Pugh Class and prior liver-directed therapy. Results: Of 352 patients, 78.7% were Child-Pugh A or B, 96.6% received first-line sorafenib, and 33.8% received first-line-prior liver-directed therapy. Survival outcomes were similar for Child-Pugh A or B, and longer after first-line prior liver-directed therapy. Conclusion: First-line systemic therapy is beneficial in patients with Child-Pugh A or B, and after first-line prior liver-directed therapy. These findings may help position systemic therapy in the community setting.

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Anesthesia for Organ Transplantation

Cited by 8 publications

References 352 publications

Association Between Flushed Fluid Potassium Concentration and Severe Postreperfusion Syndrome in Deceased Donor Liver Transplantation

Association Between Flushed Fluid Potassium Concentration and Severe Postreperfusion Syndrome in Deceased Donor Liver Transplantation

Expanded Criteria Donor-Related Hyperkalemia and Postreperfusion Cardiac Arrest During Liver Transplantation: A Case Report and Literature Review

Clinical Outcomes By Child-Pugh Class in Patients With Advanced Hepatocellular Carcinoma in a Community Oncology Setting

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