Massive Pulmonary Thromboembolism during Liver Transplantation

Navalgund, A.; Kang, Yoogoo; Sarner, J. B.; Jahr, Jonathan S.; Gieraerts, Roland

doi:10.1213/00000539-198804000-00020

Cited by 65 publications

(55 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

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%

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%

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

“…The routine use of a VVB 10 limits the hemodynamic disorders induced by clamping but has its iatrogenic risks, including thromboembolic accidents, air embolism, and infectious complications. 11,12 Moreover, its systematic use has recently been questioned with regard to the improvement of intraoperative management. 13 Preservation of the IVC was a first step of surgical advance in this area.…”

Section: Discussionmentioning

confidence: 99%

Orthotopic liver transplantation with preservation of portocaval flow compared with venovenous bypass

et al. 1997

View full text Add to dashboard Cite

Conventional liver transplantation requires crossclamping of the hepatic pedicle and inferior vena cava, leading to severe hemodynamic and metabolic disturbances, usually attenuated by the use of venovenous bypass. A more recent surgical technique, piggyback with temporary portocaval shunting, preserves both caval and portal blood flows. The aim of this study was to compare the two methods prospectively. Forty-four patients with chronic liver disease were studied. Local anatomic conditions guided the surgeon to choose the easiest way to remove the native liver. Anesthetic management was standardized. Hemodynamic and metabolic changes were assessed by use of routine tests at specific periods. Graft function was evaluated by measurement of aminotransferases and monoethylglycinexylidide (MEGX) test 12, 24, 48, and 72 hours postoperatively. Conventional liver transplantation with venovenous bypass was performed in 26 patients, and the piggyback with temporary portocaval shunting was performed in 15 patients. ANOVA showed that cardiac output and systemic oxygen delivery were better maintained before revascularization in the piggyback group. Metabolic changes were comparable, and hyperfibrinolytic activity was detected in both groups. Graft function was comparable and satisfactory within the 3 first postoperative days. Piggyback with temporary portocaval shunting provided better intraoperative hemodynamics and tissue oxygenation than liver transplantation with venovenous bypass.

show abstract

“…One patient in each group suffered massive PE. PE during OLT is rare, 20 but our study suggests that there is no increased risk for PE when HEs are incorporated into the bypass circuit.…”

Section: Neelakanta Et Almentioning

confidence: 64%

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

et al. 1998

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

Massive Pulmonary Thromboembolism during Liver Transplantation

Cited by 65 publications

References 0 publications

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

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

Orthotopic liver transplantation with preservation of portocaval flow compared with venovenous bypass

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

Contact Info

Product

Resources

About