Liver Transplant From Unexpected Donation After Circulatory Determination of Death Donors: A Challenge in Perioperative Management
| Autor: | Javier Fernández, Annabel Blasi, Josep Fuster, Graciela Martínez-Pallí, M. Navasa, Joan Beltran, Arturo Pereira, Amelia J. Hessheimer, Constantino Fondevila, Pilar Taura, Jaume Balust, Juan-Carlos García-Valdecasas |
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| Rok vydání: | 2016 |
| Předmět: |
Transplantation
medicine.medical_specialty Perioperative management business.industry medicine.medical_treatment Perioperative 030230 surgery Liver transplantation Fibrinogen 03 medical and health sciences 0302 clinical medicine Anesthesia Donation Circulatory system medicine Immunology and Allergy 030211 gastroenterology & hepatology Pharmacology (medical) Platelet Intensive care medicine business Tranexamic acid medicine.drug |
| Zdroj: | American Journal of Transplantation. 16:1901-1908 |
| ISSN: | 1600-6135 |
| Popis: | Unexpected donation after circulatory determination of death (uDCD) liver transplantation is a complex procedure, in particular when it comes to perioperative recipient management. However, very little has been published to date regarding intraoperative and immediate postoperative care in this setting. Herein, we compare perioperative events in uDCD liver recipients with those of a matched group of donation after brain death liver recipients. We demonstrate that the former group of recipients suffers significantly greater hemodynamic instability and derangements in coagulation following graft reperfusion. Based on our experience, we recommend a proactive recipient management strategy in uDCD liver transplantation that involves early use of vasopressor support; maintaining adequate intraoperative levels of red cells, platelets, and fibrinogen; and routinely administering tranexamic acid before graft reperfusion. |
| Databáze: | OpenAIRE |
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