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Abstract

Objectives: We aimed to document the anesthetic management and metabolic, hemodynamic, and clinical outcomes of liver-graft recipients who subsequently undergo nontransplant surgical procedures. Materials and Methods:We retrospectively analyzed the data of 96 liver-graft recipients who underwent 144 nontransplant surgeries between October 1998 and April 2016 at Başkent University Hospital. Results: The median patient age at the time of nontransplant surgery was 32 years, and 35% were female (n = 33). The median time between transplant and nontransplant surgery was 1231 days. The most frequent types of nontransplant surgery were abdominal (22%), orthopedic (16%), and urologic (13%). Seventy patients had an American Society of Anesthesiologists status of 2 (49%); the status was 3 in 71 patients (49%) and 4 in 3 patients (2%). Of the 144 procedures, 23 were emergent (16%) and 48% were abdominal. General anesthesia was used in 69%, regional anesthesia in 19%, and sedoanalgesia in 11%. Twenty-five patients required intraoperative bloodproduct transfusion (17%). Intraoperative hemodynamic instability developed in 17% of patients, and hypoxemia developed in 2%. Eleven patients remained intubated at the end of surgery (8%). Of the 144 procedures, 19 (13%) required transfer to the intensive care unit, 108 (75%) transferred to the ward, and the remaining 17 (12%) were discharged on the same day. Eight patients developed respiratory failure (6%), 7 had renal dysfunction (5%), 4 had coagulation abnormalities (3%), and 10 had infectious complications (7%) in the early postoperative period. The median hospital stay was 4 days, and 5 patients (4%) developed rejection during hospitalization. Five patients died of respiratory or infectious complications (4%). Conclusions: Most liver-graft recipients who undergo nontransplant surgery are given general anesthesia, transferred to the ward after the procedure, and discharged without major complications. We suggest that orthotopic liver transplant recipients may undergo nontransplant surgery without any postoperative graft dysfunction.

What is the crux of successful living‐donor liver transplantation for recipients aged 70 and beyond?

“… 22 Notably, sepsis was a common cause of mortality in both studies, especially in patients with poor PS. All three patients with American Society of Anesthesiologists (ASA) III 23 or higher died postoperatively, making it clear that elderly patients with ASA ≥ III and poor general health conditions such as PS ≥4 were not appropriate as LDLT cases.…”

Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery

“…Neostigmine can lead to bradycardia and cardiac arrest in patients with heart transplantation despite the concurrent use of an antimuscarinic agent [23]. Bupivacaine and ropivacaine can be safely used through regional routes without any side effects [24,25]. Allograft rejection may occur at any time during the post-transplant period, especially when discontinuing the use of immunosuppressants.…”

“…If an epidural or spinal anesthesia is planned, clotting studies and platelet counts should be normal. Neither regional nor general anesthetic techniques were associated with deterioration of liver function assuming proper anesthetic and intensive care management [3,25].…”