Fatal Pulmonary Embolism during Liver Transplantation

Sopher, Michael; Braunfeld, Michelle; Shackleton, Christopher R.; Busuttil, Ronald W.; Sangwan, Susheela; Csete, Marie

doi:10.1097/00000542-199708000-00033

Cited by 64 publications

(52 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several factors are related to the patient: sepsis, the migration of preexisting thrombi, intraoperative hypotension, and protein C and S deficiencies. 4,7,9,10,12,13,17,18 Others are inherent to the OLT procedure: excessive activation of the coagulation system, venous stasis during clamping of the portal vein and inferior vena cava, and release of activators from the liver graft. 6,7,9 In addition, other conditions such as heparin-induced thrombocytopenia, factor V Leiden, and antithrombin deficiency can contribute to thrombosis and possibly ICTs during OLT.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, intraoperative management may play an important role: PA catheter placement; the administration of antifibrinolytics, anti-hepatitis B immunoglobulin, and blood products; and the intraoperative utilization of continuous venovenous filtration. 2,4,7,8,[10][11][12][13][14][18][19][20] Risk factor analysis for ICTs during OLT has proved to be difficult because of the relatively low incidence. In this study, we showed that symptomatic and/or surgically treated portal hypertension and intraoperative hemodialysis were independent risk factors for the development of incidental ICTs during OLT.…”

Section: Discussionmentioning

confidence: 99%

“…The thromboemboli in these cases are usually described as large, massive, severe, or fatal; these terms refer to the clot size, the impact on hemodynamics, or the patient outcomes (the term massive is used throughout this report). [3][4][5][6][7][8][9][10][11][12][13][14] The diagnosis of massive thromboemboli can be made on the basis of a typical clinical presentation with or without transesophageal echocardiography (TEE) evidence. Several strategies have been reported for the management of massive thromboemboli during OLT.…”

mentioning

confidence: 99%

“…6,[9][10]13 Despite aggressive pharmaceutical or surgical interventions, the overall mortality rate for patients with thromboemboli during OLT remains high, and a majority of the patients die intraoperatively.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Incidental intracardiac thromboemboli during liver transplantation: Incidence, risk factors, and management

Xia

Nourmand

et al. 2010

Liver Transpl

View full text Add to dashboard Cite

Even though numerous cases of massive thromboemboli have been reported in the literature, intracardiac thromboemboli (ICTs) incidentally found during orthotopic liver transplantation (OLT) have not been examined. In this study, we retrospectively examined the incidence, risk factors, and management of incidental ICTs during OLT. After institutional review board approval, adult patients who underwent OLT between January 2004 and December 2008 at our center were reviewed. ICTs were identified and confirmed by the examination of OLT datasheets, anesthesia records, and recorded transesophageal echocardiography (TEE) clips. The clinical presentation, management, and outcomes of the patients with ICTs were reviewed. Risk factors were analyzed by multivariate logistic regression. During the study period, 426 of the 936 adult OLT patients (45.5%) underwent intraoperative TEE monitoring. Incidental ICTs were identified in 8 of these 426 patients (1.9%). Two ICTs occurred before reperfusion, and 6 ICTs occurred after reperfusion. The treatment was at the discretion of the treating physicians; however, none of the patients received an anticoagulant or thrombolytics. Multivariate analysis identified 2 independent risk factors for intraoperative incidental ICTs: the presence of symptomatic or surgically treated portal hypertension (a history of gastrointestinal bleeding, a transjugular intrahepatic portosystemic shunt procedure, or portocaval shunt surgery) before OLT and intraoperative hemodialysis (odds ratios of 4.05 and 7.29, respectively; P < 0.05 for both). In conclusion, incidental ICTs during OLT occurred at a rate of 1.9% and were associated with several preoperative and intraoperative risk factors. The use of TEE allows early identification, which may be important. Our management for incidental ICTs is described; however, no conclusions can be made about the optimal therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Incidental intracardiac thromboemboli during liver transplantation: Incidence, risk factors, and management

Xia

Nourmand

et al. 2010

Liver Transpl

View full text Add to dashboard Cite

show abstract

“…These last 2 patients are the subject of a separate report. 3 Hematuria occurred in 6 patients during or immediately after the anhepatic phase. Five of these patients were managed with HEs.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of heat exchanger added to venovenous bypass circuit during orthotopic liver transplantation

et al. 1998

Self Cite

View full text Add to dashboard Cite

Hypothermia during orthotopic liver transplantation (OLT) is common despite measures to prevent this complication. We retrospectively analyzed two groups of patients; those managed with (n ‫؍‬ 113) or without (n ‫؍‬ 109) a heat exchanger (HE) incorporated in the venovenous bypass (VVB) circuit to test the hypothesis that normothermia before liver reperfusion minimizes hypotension during reperfusion and decreases neohepatic transfusion requirements. Use of the HE resulted in significantly warmer patients during reperfusion and at the end of surgery (P F .001). An increase in neohepatic transfusion requirement was observed in patients with HE use: packed red blood cells, 4 ؎ 4 versus 3 ؎ 3 units; fresh-frozen plasma, 5 ؎ 5 versus 4 ؎ 4 units; platelets, 8 ؎ 8 versus 6 ؎ 7 units; and cryoprecipitate, 5 ؎ 7 versus 3 ؎ 5 units. There was no difference between the two groups in the untoward hemodynamic events during reperfusion of the liver (P ‫؍‬ .31). We conclude that during OLT, the use of an HE in a nonheparinized VVB circuit helps maintain normothermia. Our limited experience suggests that its use is safe but does not improve hemodynamic stability during reperfusion or decrease blood loss during the neohepatic period.

show abstract

The prophylactic use of tranexamic acid and aprotinin in orthotopic liver transplantation: A comparative study

et al. 2004

View full text Add to dashboard Cite

The efficacy of tranexamic acid (TA) and aprotinin (AP) in reducing blood product requirements in orthotopic liver transplantation (OLT) was compared in a prospective, randomized and double-blind study. One hundred and twenty seven consecutive patients undergoing OLT were enrolled; TA was administered to 64 OLT patients at a dose of 10mg /kg/h and aprotinin was administered to 63 OLT patients at a loading dose of 2x10 6 KIU followed by an infusion of 500,000 KIU/h. The portocaval shunt could not be performed in 14 OLT patients in the TA group and in 13 OLT patients in the AP group. However, all OLT patients that received either drug were included in the analysis. Perioperative management was standardized. Hemogram, coagulation tests, and blood product requirements were recorded during OLT and during the first 24 hours. No differences in diagnosis, Child score, preoperative coagulation tests, and intraoperative data were found between groups. No significant differences were observed in hemogram and intraoperative coagulation tests with the exception of activated partial thromboplastin time (aPTT). Similarly, there were no intergroup differences in transfusion requirements. Thromboembolic events, reoperations and mortality were similar in both groups. In conclusion, administration of regular doses of TA and AP during OLT did not result in large differences between the two groups. (Liver Transpl 2004; 10:279 -284.)

show abstract

Fatal Pulmonary Embolism during Liver Transplantation

Cited by 64 publications

References 18 publications

Incidental intracardiac thromboemboli during liver transplantation: Incidence, risk factors, and management

Incidental intracardiac thromboemboli during liver transplantation: Incidence, risk factors, and management

Efficacy and safety of heat exchanger added to venovenous bypass circuit during orthotopic liver transplantation

The prophylactic use of tranexamic acid and aprotinin in orthotopic liver transplantation: A comparative study

Contact Info

Product

Resources

About