Liver Transplantation Complications in the Intensive Care Unit and at 6 Months

Tenza, Eva María Olivares; Bernardo, Carmen García; Escudero, D.; Otero, Jesús María Garagorri; Quindós, B.; Miyar, A.; Vázquez, L; Taboada, Francisco; Rodríguez, Minerva; González‐Diéguez, Luisa; González-Pinto, I; Barneo, L

doi:10.1016/j.transproceed.2009.02.014

Cited by 20 publications

(12 citation statements)

References 4 publications

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“…(1, 35, 38, 41, 50, 54-62) Eight studies reported rates of pneumonia, with a combined incidence of 0.115 (95% CI = 0.054 to 0.195). Five studies each reported rates of pulmonary edema (Pooled proportion = 0.202 (95% CI = 0.064, 0.391)) and pleural effusion (combined incidence 0.379 (95% CI = 0.092 to 0.724)).…”

Section: Resultsmentioning

confidence: 99%

A meta-analysis of complications following deceased donor liver transplant

McElroy¹,

Daud²,

Davis³

et al. 2014

The American Journal of Surgery

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Background Liver transplantation is a complex surgery associated with high rates of postoperative complications. While national outcomes data are available, national rates of most complications are unknown. Data Sources A systematic review of the literature reporting rates of postoperative complications between 2002 and 2012 was performed. A cohort of 29,227 deceased donor liver transplant recipients from 74 studies was used to calculate pooled incidences were for 17 major postoperative complications. Conclusions This is the first comprehensive review of postoperative complications after liver transplantation and can serve as a guide for transplant and non-transplant clinicians. Efforts to collect national data on complications, such as through the National Surgical Quality Improvement Program, would improve the ability to provide patients with informed consent, serve as a tool for individual center performance monitoring, and provide a central source against which to measure interventions aimed at improving patient care.

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Section: Resultsmentioning

confidence: 99%

A meta-analysis of complications following deceased donor liver transplant

McElroy¹,

Daud²,

Davis³

et al. 2014

The American Journal of Surgery

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“…7 Transfusion of red blood cells (RBCs), fresh-frozen plasma (FFP), and PLTs has been shown to be associated with increased morbidity and mortality in major liver surgery and transplantation. [8][9][10][11] Prophylactic use of recombinant activated FVII has been recommended, but this treatment failed to reduce transfusion requirements in LT in a multicenter, randomized trial. 12 Moreover, the incidence of arterial thrombotic events was significantly higher compared to controls (5.5% vs. 3.2%, p = 0.003).…”

mentioning

confidence: 99%

Coagulation management with factor concentrates in liver transplantation: a single‐center experience

et al. 2014

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BACKGROUND: Allogeneic blood products transfusion during liver transplantation (LT) can be associated with increased morbidity and mortality. Data on thromboelastometry (ROTEM)-guided coagulation management with coagulation factor concentrates (CFCs)-fibrinogen concentrate and/or prothrombin complex concentrate (PCC)-are sparse. We aimed to retrospectively evaluate the safety events observed with this approach in our clinic. STUDY DESIGN AND METHODS: LT patients from January 2009 to December 2010 (n = 266) were identified by chart review. A ROTEM-based algorithm with CFC guided the hemostatic therapy. Doppler ultrasound was used to evaluate thrombosis in the hepatic artery, portal vein, and hepatic veins. Stroke, myocardial isch-emia, pulmonary embolism, and transfusion variables were recorded. Patients receiving CFC were included in the CFC group (n = 156); those not receiving CFC were included in the non-CFC group (n = 110). Safety events were compared between these two groups. RESULTS: Allogeneic transfusion(s) in the 266 patients was low, with medians of 2 (interquartile range [IQR], 0-5), 0 (IQR 0-0), and 0 (IQR 0-1) units for red blood cells (RBCs), fresh-frozen plasma (FFP), and platelets (PLTs), respectively. Ninety-seven of 266 LTs (36.5%) were performed without RBCs transfusion, 227 (85.3%) without FFP, and 190 (71.4%) without PLTs. There were no significant differences in thrombotic, thrombo-embolic, and ischemic adverse events occurrence between the CFC group and the non-CFC group (11/ 156 patients vs. 5/110; p = 0.31). CONCLUSION: In LT, ROTEM-guided treatment with fibrinogen concentrate and/or PCC did not appear to increase the occurrence of thrombosis and ischemic events compared to patients who did not receive these concentrates. T he median model of end-stage liver disease (MELD) score in EUROTRANSPLANT has increased from 25 to 35 (match-MELD) in the past 6 years, attributable to the adoption of MELD score as the basis for organ allocation in liver trans-plantation (LT). 1 This increase is associated with an increased risk of bleeding. 2 However, chronic liver disease is associated with multiple changes in coagulation status. On the one hand, the activity and levels of vitamin K-dependent coagulation factors (II, VII, IX, and X) and coagulation inhibitors (protein C and S) are decreased, as well as platelet (PLT) count. 3 Levels of tissue factor-expressing cells, von Willebrand factor, and coagulation Factor (F)VIII are often increased. 4,5 The concomitant reduction of pro-and anticoagulants typically leads to rebalanced hemostasis, but the low levels of pro-and anti-coagulants mean that the balance can be easily disturbed, ABBREVIATIONS: ALI = acute lung injury; aPTT = activated partial thromboplastin time; CFC(s) = coagulation factor concentrate(s); HAT = hepatic artery thrombosis; ICU = intensive care unit; INR = international normalized ratio; IQR = interquartile range; LT(s) = liver transplantation(s); MELD = median model of end-stage liver disease; PCC(s) = prothrombin complex concentrate(...

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“…An independent negative predictive factor was serum urea nitrogen level during ICU stay in patients with late ICU admission. 10 In our group of patients with ARF, severe sepsis and septic shock were more frequently observed, with 17 of 22 patients with ARF having increased levels of serum urea nitrogen and creatinine due to renal dysfunction.…”

Section: Funda Atar Et Al/experimental and Clinical Transplantation (mentioning

confidence: 63%

Untitled

Atar

Gedik²,

Kaplan³

et al. 2015

Exp Clin Transplant

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Results: Among 173 patients, 37 (21.4%) were admitted to an intensive care unit, including 22 (59.5%) with acute respiratory failure. The leading cause of acute respiratory failure was pneumonia (n = 19, 86.4%). Patients with acute respiratory failure had significantly lower levels of albumin before intensive care unit admission (P = .003). In patients with acute respiratory failure, severe sepsis and septic shock were more frequently observed and tracheotomy was more frequently performed (P = .041). Conclusions: Acute respiratory failure developed in 59.5% of liver transplant recipients with late intensive care unit admission. The leading cause was pneumonia, with this group of patients having higher requirements for invasive mechanical ventilation and tracheotomy, longer stays in an intensive care unit, and higher mortality.

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Liver Transplantation Complications in the Intensive Care Unit and at 6 Months

Cited by 20 publications

References 4 publications

A meta-analysis of complications following deceased donor liver transplant

A meta-analysis of complications following deceased donor liver transplant

Coagulation management with factor concentrates in liver transplantation: a single‐center experience

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