Preoperative Recipient Parameters Allow Early Estimation of Postoperative Outcome and Intraoperative Transfusion Requirements in Liver Transplantation

Schumacher, Carsten; Eismann, Hendrik; Sieg, Lion; Friedrich, Lars; Scheinichen, Dirk; Vondran, Florian W. R.; Johanning, Kai

doi:10.1177/1526924818765805

Cited by 5 publications

(13 citation statements)

References 31 publications

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“…Age at the time of LT was 51 [44.5-57.5] years with a BMI of 23.7 [20.8-26.9] kg/m2. MELD score, the scoring system for assessing the severity of chronic liver disease [7], was 15 [12][13][14][15][16][17][18][19][20][21][22] and the diseases indicating LT were post infection liver cirrhosis (n = 8, 61.5%) which was associated with hepatocellular carcinoma in the 75% of cases (n = 6), alcoholic cirrhosis (n = 2, 15.4%), primary biliary cirrhosis (n = 1, 7.7%), alpha-1 antitrypsin deficiency (n = 1, 7.7%) and hemochromatosis (n = 1, 7.7%), (…”

Section: Resultsmentioning

confidence: 99%

“…In fact, despite several investigations have attempted to identify preoperative predictors of blood transfusion, their value remain inconsistent and weak [2,[8][9][10][11][12][13][14]. In recent years, models to predict blood utilization with preoperative variables have been proposed [11,14,15]. However, their limitations and differences in the results highlight significant concerns about their generalizability and recognize that it may be very difficult to develop a single, reliable, and universally applicable model to predict transfusion requirements for patients undergoing LT.…”

Section: Discussionmentioning

confidence: 99%

“…The adoption of a fluid restriction policy and low CVP is important as it results helpful in decreasing blood transfusion requirements during LT [8,16]. In fact, liberal volume loading in cirrhotic patients tends to pool in the splanchnic circulation with minimal improvement in cardiac preload or output but increased risk of surgical bleeding because of congestion of the portal circulation [9,10,15]. Moreover, dilution of clotting factors and clot disturbance can result, particularly if colloids are used [2,13].…”

Section: Discussionmentioning

confidence: 99%

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Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single institution

et al. 2020

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Background: Jehovah's Witnesses represent a tremendous clinical challenge when indicated to liver transplantation because they refuse blood transfusion on religious grounds and the procedure is historically associated with potential massive peri-operative blood loss. We herein describe a peri-operative management pathway with strategies toward a transfusion-free environment with the aim not only of offering liver transplant to selected Jehovah's Witnesses patients but also, ultimately, of translating this practice to all general surgical procedures. Methods: This is a retrospective review of prospective medical records of JW patients who underwent LT at our Institution. The peri-operative multimodal strategy to liver transplantation in Jehovah's Witnesses includes a pre-operative red cell mass optimization package and the intra-operative use of normovolemic haemodilution, venovenous bypass and low central venous pressure. Results: In a 9-year period, 13 Jehovah's Witness patients received liver transplantation at our centre representing the largest liver transplant program from deceased donors in Jehovah's Witnesses patients reported so far. No patient received blood bank products but 3 had fibrinogen concentrate and one tranexamic acid to correct ongoing hyperfibrinolysis. There were 4 cases of acute kidney injury (one required extracorporeal renal replacement treatment) and one patient needed vasoactive medications to support blood pressure for the first 2 postoperative days. Two patients underwent re-laparotomy. Finally, of the 13 recipients, 12 were alive at the 1 year follow-up interview and 1 died due to septic complications. Conclusions: Our experience confirms that liver transplantation in selected Jehovah's Witnesses patients can be feasible and safe provided that it is carried out at a very experienced centre and according to a multidisciplinary approach.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single institution

et al. 2020

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“…5-57.5] years with a BMI of 23.7 [20.8-26.9] kg/m2. MELD score, the scoring system for assessing the severity of chronic liver disease 8 , was 15 [12][13][14][15][16][17][18][19][20][21][22] and the diseases indicating LT were post infection liver cirrhosis (n = 8, 61.5 %) which was associated with hepatocellular carcinoma in the 75% of cases (n = 6), alcoholic cirrhosis (n = 2, 15.4 %), primary biliary cirrhosis (n = 1, 7.7 %), alpha-1 antitrypsin deficiency (n = 1, 7.7 %) and hemochromatosis (n = 1, 7.7 %), ( Table 2 whereas Table 3 Finally, of the 13 JW recipients, 12 (92.3 %) were alive at the 1 year follow-up interview: 1 patient died 11 months from LT due to ischemic-type biliary lesions (ITBL)-related septic complications.…”

Section: Resultsmentioning

confidence: 99%

“…In fact, despite several investigations have attempted to identify preoperative predictors of blood transfusion, their value remain inconsistent and weak 3,[9][10][11][12][13][14][15] . In recent years, models to predict blood utilization with preoperative variables have been proposed 12,[15][16] . However, their limitations and differences in the results highlight significant concerns about their generalizability and recognize that it may be very difficult to develop a single, reliable, and universally applicable model to predict transfusion requirements for patients undergoing LT.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single Institution

Costanzo

Bindi

Ghinolfi

et al. 2019

Preprint

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Jehovah's Witnesses represent a tremendous clinical challenge when indicated to liver transplantation because they refuse blood transfusion on religious grounds and the procedure is historically associated with potential massive peri-operative blood loss. We developed a peri-operative management pathway with strategies toward a transfusion-free environment in the respect of the patients’ religious beliefs. Briefly, our peri-operative multimodal strategy to liver transplantation in Jehovah's Witnesses includes a pre-operative red cell mass optimization package and the intra-operative use of normovolemic haemodilution, veno-venous bypass and low central venous pressure. In a 9-year period, 13 Jehovah’s Witness patients received liver transplantation at our centre representing the largest LT program from deceased donors in JW patients that has been reported so far. No patient received blood bank products but 3 had fibrinogen concentrate and one tranexamic acid to correct ongoing hyper-fibrinolysis. There were 4 cases of acute kidney injury (one required extracorporeal renal replacement treatment) and one patient needed vasoactive medications to support blood pressure for the first 2 postoperative days. Two patients underwent re-laparotomy. Finally, of the 13 recipients, 12 were alive at the 1 year follow-up interview and 1 died due to septic complications. Our experience confirms that liver transplantation in selected Jehovah's Witnesses patients can be feasible and safe provided that it is carried out at a very experienced centre and according to a multidisciplinary approach

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The value of preoperative spirometry testing for predicting postoperative risk in upper abdominal and thoracic surgery assessed using big-data analysis

Park¹,

Kim²,

Kim³

et al. 2020

J Thorac Dis

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Background:Spirometry is used to evaluate postoperative outcomes in thoracic surgery. However, the clinical utility of spirometry for predicting postoperative complications has not been determined. We used big-data analysis to examine the relationship between pulmonary function tests and postoperative complications. Methods:We retrospectively analysed clinical data from 31,827 patients who underwent spirometry within the 3 months prior to their surgery between January 2000 and December 2014 at a single tertiary referral hospital. The data were extracted in de-identified form via the automated clinical research information system. Surgical procedures included thoracic and upper abdominal surgery. Results:Multivariable logistic regression analysis showed that type of surgery, older age (>65 years), low albumin and smoking were associated with postoperative infections [95% confidence interval (CI) of the odds ratio (OR) 1.27-1.60 (>65 years); 1.52-1.96 (low albumin); 1.40-1.98 (current smoker)]. Notably, lower forced vital capacity (FVC) was an independent risk factor for postoperative infection, prolonged intensive care unit stay, and in-hospital death, regardless of airflow limitation [OR 95% CI: 1.31-1.69 (FVC 50-80%); 2.02-4.24 (FVC <50%)]. Lower forced expiratory volume in 1 sec (FEV 1 ) was also an independent risk factor for postoperative infection [OR 95% CI: 1.61-2.26 (FEV 1 50-80%); 2.27-4.21 (FEV 1 <50%)]. Airflow limitation assessed by FEV 1 was negatively correlated with postoperative infection in multivariable analysis (OR 95% CI: 0.51-0.88). Conclusions:Lower preoperative FVC could be used to predict postoperative infection and complications in thoracic and upper abdominal surgery regardless of airflow limitation.

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Preoperative Recipient Parameters Allow Early Estimation of Postoperative Outcome and Intraoperative Transfusion Requirements in Liver Transplantation

Abstract: A score based on preoperative creatinine, leukocyte, and platelet values allowed early estimation of postoperative 30- and 90-day outcomes and intraoperative transfusion requirements in liver transplantation. Results might help to improve timely logistic and personal strategies.

Cited by 5 publications

References 31 publications

Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single institution

Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single institution

Liver transplantation in Jehovah’s witnesses: 13 consecutive cases at a single Institution

The value of preoperative spirometry testing for predicting postoperative risk in upper abdominal and thoracic surgery assessed using big-data analysis

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