Two cases of central venous catheter‐related thrombosis in living liver donors: how can the risk be minimized?

Hata, Toshiaki; Fujimoto, Yasuhiro; Suzuki, Kôjiro; Kim, Byeoknyeon; Ishigami, Masatoshi; Ogawa, Hayato; Arikawa, Takashi; Nagai, Shunji; Kamei, Hideya; Nakamura, Taro; Edamoto, Yoshihiro; Kiuchi, Tetsuya

doi:10.1111/j.1399-0012.2008.00939.x

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…Moreover, blood loss was similar in donors with and without CVP monitoring, suggesting CVP monitoring may not be necessary [22]. Importantly, central venous catheterisation via the internal jugular or subclavian vein is associated with its own morbidity [24,25], and central venous catheterrelated thrombosis has been observed in living liverdonors [26]. Taken together, these findings suggested that a low CVP technique may not have advantages during living-donor hepatectomy.…”

Section: Discussionmentioning

confidence: 93%

Effect of stroke volume variation‐directed fluid management on blood loss during living‐donor right hepatectomy: a randomised controlled study

et al. 2015

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Summary Reducing blood loss is beneficial in living liver donor hepatectomy. Although it has been suggested that maintaining a low central venous pressure is important, it is known that low stroke volume variation may be associated with increased blood loss. Therefore, we compared the effect on blood loss of 40 patients randomly assigned to a high stroke volume variation group (maintaining 10–20% of stroke volume variation) vs 38 patients in a control group (maintaining < 10% stroke volume variation) during living‐donor right hepatectomy. Mean (SD) blood loss during donor hepatectomy was significantly lower in the high stroke volume variation group than in the control group: 476 (131) ml vs 836 (341) ml, respectively (p < 0.001). Blood pressure and peri‐operative laboratory values did not differ between the two groups. However, in the high stroke volume variation group, central venous pressure values were also significantly lower. We were unable to disentangle the effects of stroke volume variation and central venous pressure, but our results confirm that the two together appear beneficial.

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Section: Discussionmentioning

confidence: 93%

Effect of stroke volume variation‐directed fluid management on blood loss during living‐donor right hepatectomy: a randomised controlled study

et al. 2015

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“…To prevent thrombosis that cannot be predicted by screening, routine use of elastic stockings and early ambula-tion are necessary. In addition, the risk from use of a central venous catheter in donors was recently shown in another report from our institute (21). Thus, it is important to carefully consider the use of a central venous catheter, particularly in candidates with risk factors and those similar to the present Borderline group.…”

Section: Discussionmentioning

confidence: 74%

Donor screening algorithm for exclusion of thrombophilia during evaluation of living donor liver transplantation

Ogawa¹,

Fujimoto²,

Yamamoto

et al. 2011

Clinical Transplantation

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Living donor liver transplantation (LDLT) has evolved based on the premise that donor safety is most important. In 2005, we encountered a donor who developed a pulmonary embolism during the early post-operative period. As it is important for donors to be healthy, most risk factors related to perioperative thrombosis, such as obesity, age, and malignancy are used as exclusion criteria during the evaluation process. We speculated that thrombophilia not detected by conventional laboratory examinations may cause post-operative thrombotic complications and should be investigated by application of additional parameters, including protein S, protein C, antithrombin III, anti-β2-glycoprotein I antibodies (anti-β2GPI), and lupus anticoagulant. From July 2005 to June 2007, we evaluated 44 donor candidates for LDLT using our novel algorithm for screening of thrombophilia, which revealed two suspected candidates (one with low protein S, one with low protein C, and positive anti-β2GPI findings), who were subsequently excluded from the donor pool. Thereafter, all donor hepatectomies, which included two borderline donors given anticoagulants perioperatively, were performed without complications. Four donors (two suspected, two borderline) would not have been recognized without additional screening. In conclusion, we were able to detect thrombophilia and avoid donor thrombosis using additional screening criteria and our novel algorithm.

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“…However several studies have stated that CVP did not correlate with bleeding during the hepatectomy [19][20][21], Besides, there are potential fatal risks of low CVP strategies during hepatectomy include air embolism and tissue hypoperfusion [22], it was also reported by Jones et al [15] that a small air embolism was noticed in two patients (5% of patients with low CVP), Another important issue should be taken into consideration; the complication of central venous catheterization is from 5% to 26% in all patients required treatment and monitoring [23].…”

Section: Introductionmentioning

confidence: 89%

Internal jugular vein distensibility in assessment of fluid responsiveness in donors of living donor liver transplantation

Abdou

Ammar

2018

Egyptian Journal of Anaesthesia

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Background: The concept of brain death is still not acceptable nor implemented in Egypt. Donor safety in liver transplantation is on the top of our priorities. Purpose: The purpose of this study is to evaluate the effectiveness of using IJV distensibility as a reliable method for intraoperative assessment of fluid responsiveness. Methods: A prospective observational study was conducted in Ain Shams university specialized hospitals. 40 donor candidates for right lobe hepatectomy for living donor liver transplantation were enrolled. During period of hypovolemia (T0) left IJV scanned and measured. After a given fluid bolus in the form of ringer acetate 5 ml/ kg. ultrasonic and hemodynamic measurements were reassessed 10 min (T 10) after the fluid resuscitation. Results: Highly significant changes in MABP, HR, and CVP (p < 0.01) were detected after fluid resuscitation, regarding the IJV distensibility it showed a highly significant reduction from baseline (T0) to post-resuscitation expansion (P = 0.0001). Baseline (T0) measurements showed no significant correlation between IJV distensibility and hemodynamic parameters (P ≥ 0.05). Post-resuscitation values (T10) showed no significance correlation between HR and IJV distensibility (P = 0.772). On the other side it showed a highly significance negative correlation between MABP, CVP and IJV distensibility (r = −0.390, P = 0.013) and (r = −0.332 * , p = 0.036) respectively. The correlation between the percentages of change of IJV distensibility and hemodynamic parameters showed highly significant negative correlation between IJV distensibility and MABP (r = −0.359, P = 0.023) also with CVP (r = −0.464, P = 0.017). No difference was found regarding the HR (P = 0.336). Conclusion: Organ transplantation centers with experience, CVP monitoring may not be necessary in highly selective patient population. IJV distensibility, a non-invasive and safe method can be used to guide fluid replacement in healthy donor.

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Two cases of central venous catheter‐related thrombosis in living liver donors: how can the risk be minimized?

Cited by 4 publications

References 19 publications

Effect of stroke volume variation‐directed fluid management on blood loss during living‐donor right hepatectomy: a randomised controlled study

Effect of stroke volume variation‐directed fluid management on blood loss during living‐donor right hepatectomy: a randomised controlled study

Donor screening algorithm for exclusion of thrombophilia during evaluation of living donor liver transplantation

Internal jugular vein distensibility in assessment of fluid responsiveness in donors of living donor liver transplantation

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