Transplant Center Experience Research Articles

1114 The Effect of Metabolic Syndrome on Acetaminophen-Induced Acute Liver Injury/Failure - Morbidity and Mortality: A Single Liver Transplant Center Experience

INTRODUCTION: Acetaminophen (N-acetyl-p-aminophenol; APAP) toxicity is a major cause of acute liver injury in USA. Several risk factors could increase the risk and severity of APAP-induced acute liver injury/failure (APAP-ALI/ALF), including malnutrition, chronic hepatitis C, alcoholism, hepatic cytochrome P450-inducing medications, and pre-existing liver disease. Whether metabolic syndrome affects the risk or the severity of APAP-ALI/ALF has not been definitively confirmed. Clinical and animal studies show conflicting results. We aim to assess the effect of pre-existing metabolic syndrome on the natural history of APAP-ALI/ALF, including morbidity and mortality METHODS: This was a retrospective study performed at a tertiary care liver transplant center. A collective database of all patients with APAP-ALI/ALF from 2001-2012 was reviewed. Primary outcomes were 28-day mortality and the need for liver transplantation. Secondary outcomes were the degree of liver injury and elevation of biochemical markers RESULTS: A total of 327 patients were evaluated with APAP-ALI/ALF. A subset of 219 patients who had a recorded BMI in the medical record were included for analysis. There were 151 females and 68 males, with a mean age of 39.1 years old. Benzodiazepine or opioid co-ingestion occurred in 116 patients. A total of 60 patients were obese (BMI > 30 Kg/m2) with a mean BMI of 38.3 Kg/m2, and 21 were morbidly obese (BMI > 40 Kg/m2). 58 patients died (24 obese and 34 non-obese). Liver transplantation was performed in 4 out of the 7 patients who were listed. There was a statistically significant association between obesity and the 28-day mortality, OR 2.451 (95% CI 1.291-4.651) and P 0.005. No significant association was found between obesity and either listing for liver transplantation or liver transplantation (P 0.351 and 0.916 respectively). Maximum total bilirubin and INR were slightly higher in obese patients; however, this was not statistically significant (P 0.08 and 0.823, respectively). Pearson correlation showed a weak association between rising BMI and a higher maximum total bilirubin and INR, but this was not statistically significant (r 0.08, P 0.201 for total bilirubin and r 0.07, P 0.307 for INR) CONCLUSION: Our study demonstrates that obesity is associated with a higher mortality in patients with APAP-ALI/ALF. Preexisting hepatocyte lipid accumulation, CYP2E1 induction, reduced hepatic glutathione stores as well as mitochondrial dysfunction have been proposed as risk factors that may be contributing.

Indications for lung transplant referral and listing.

Lung transplantation is a valuable therapeutic option for many patients with severe lung disease who have exhausted other medical or surgical therapies. However, since lungs are not a manufacturable organ like artificial heart valves or left ventricular assist devices, and since they are a limited resource compared to number of patients requiring the organs, the Department of Health and Human Services set the Final Rule of organ allocation in 1998. This led to development and implementation of Lung Allocation Score (LAS) in 2005. The score broadly divides lung diseases into 4 diagnostic criteria with a coefficient factor given to each category. The score is based on the prognostic factors of each patient to determine the risk of mortality without a transplant combined with the probability of patient survival post-transplant. Most of the guidelines for "Indications for referral and listing in lung transplant" is based on consensus opinion as there is limited amount of robust data and trials about this topic. The International Society for Heart and Lung Transplant (ISHLT) has published three editions for candidate selection and listing. In this article, we have attempted to highlight the guidelines and incorporated other disease specific prognostic factors that are not captured in the LAS. Ultimately, there are other factors like geographic location, height, blood group, preformed antibodies, transplant center experience, past wait times and transplant rate, availability of organs, etc., which also play a role especially when considering listing a patient for lung transplant. We also highlighted a representative disease in each category and most criteria for that disease will apply to other diseases in that category. Finally, this article does not delve into the history and reasoning behind each guideline but is meant to provide a general overview of indications and contraindications applicable in the field of adult lung transplantation.

Unmanipulated haploidentical transplantation for adult patients with hematological malignancies.

Unmanipulated haploidentical transplantation for adult patients with hematological malignancies.

Evaluation of the first liver transplantations in our transplant center experience

PurposeOrthotopic liver transplantation is life-saving in patients with end-stage liver failure. However, infections and acute rejection are the most important causes of morbidity and mortality. Liver transplantation in the treatment of liver failure has begun to be implemented for the first time in Pamukkale University Medical Faculty Health Research and Training Hospital, and the results of liver transplants are shared in this report. Material and methodA total of five cadaveric donor liver transplantation cases were evaluated prospectively. Patients' demografic findings and infectious complications detected after transplantation were examined. FindingsTwo of the patients was male, three were female. The mean age was 57.8 ± 9.9 years and the mean MELD score was 12.8 ± 2.4. The organisms isolated included Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa. Two patients’ had blood stream infection with urinary tract infection (UTI) and one patients’ had postoperative wound infection after bilary leakage. One patients’ developed pneumonia. One patient was developed tacrolimus-induced severe persistent diarrhea and recovered thereafter reduced tacrolimus dose. One of the patients died of post-op 3 days because of reperfusion syndrome. ConclusionNew liver transplantation practices in our country will make many diseases that cause liver failure become treatable as in our transplant center. The duration of hospital stay, intensive care unit stay, invasive interventions, blood transfusions, immunosuppressive treatments cause an increased risk of infection in these patients and high mortality is seen despite antibiotic treatment.

Comparative Analysis of Conditioning Regimens in Patients Undergoing Autologous Hematopoietic STEM CELL Transplant for Lymphoma in a Single Brazilian Center

Introduction The use of myeloablative conditioning regimen followed by autologous hematopoietic stem cell infusion is considered as standard of care for the first or second line treatment for diverse types of lymphoma. However, studies comparing different conditioning regimens are not frequent, and its choice can be based on transplant center's experience. In the last few years, our center had different choices due to the unavailability of some chemotherapy drugs, and the main options were BEAM, CBV and busulfan based regimen (BuMel). Objective Perform a comparative analysis among the three conditioning regimens used in our center, assessing the impact on toxicity and survival. Methods A retrospective cohort including lymphoma patients, who underwent first autologous transplant at our center from January 2014 to December 2017, were evaluated regarding toxicity - renal, hepatic, cardiovascular, gastrointestinal (including diarrhea) - as primary endpoint, doing paired analysis - according to the CTCAE (v 4.0). Results 120 patients were included – 46 patients used BEAM, 44 patients used CBV, and 30 patients used BuMel as conditioning regimen. Regarding patient's characteristics, there was no statistically difference in gender, type of lymphoma, and age. We observed distinct toxicity profiles between the groups. For renal toxicity, there was a difference between CBV (34.1%) and BEAM (11.1%), p=0.02. For hepatic toxicity, CBV (59.1%) was different than BuMel (16.7%), p=0.0008, and BEAM (13.0%), p Conclusion Our data did not show major differences in toxicities and other complications among the three conditioning groups. There was no impact on disease-free and overall survival. Therefore, all three options can be feasible as conditioning regimen for patients with lymphoma.

Donation After Cardiac Death: A Necessary Expansion for Heart Transplantation

The gold standard and sole curative therapy for advanced stage heart failure is cardiac transplantation. As the population ages, the number of patients diagnosed with advanced heart failure and listed for transplant steadily increases annually. However, there remains a paucity of eligible donation after brain death (DBD) donor hearts which severely limits access to cardiac transplantation and leads to increasing wait-list times and avoidable patient mortalities. Though the first human heart transplant in 1967 was performed using a deceased donor heart, the advent of brain death criteria and the ability to avoid long warm ischemic times led donation after cardiac death (DCD) transplantation to fall out of favor. Due the current state of cardiac transplantation, there has been a resurgence in interest in DCD heart transplantation leading to the development of DCD heart transplantation programs in the UK and Australia after positive reports of successful DCD cardiac transplantation in the pediatric literature. These programs have demonstrated favorable post-transplantation outcomes equivalent to matched traditional DBD transplants with current techniques and strict donor criteria. This technique has been proven safe with favorable outcomes and has been demonstrated to significantly increase transplant volumes and decrease patient mortality. Given these outcomes and the high patient benefit to risk ratio, DCD donor heart transplantation is necessary to expand the donor pool and decrease patient mortality and should be developed in high volume experienced cardiac transplant centers.

Impact of non-oncological and oncological factors on tumor recurrence in HCC liver transplanted patients – single liver transplant centre experience

Impact of non-oncological and oncological factors on tumor recurrence in HCC liver transplanted patients – single liver transplant centre experience

Split liver transplantation: Current developments.

In 1988, Rudolf Pichlmayr pioneered split liver transplantation (SLT), enabling the transplantation of one donor liver into two recipients - one pediatric and one adult patient. In the same year, Henri Bismuth and colleagues performed the first full right/full left split procedure with two adult recipients. Both splitting techniques were rapidly adopted within the transplant community. However, a SLT is technically demanding, may cause increased perioperative complications, and may potentially transform an excellent deceased donor organ into two marginal quality grafts. Thus, crucial evaluation of donor organs suitable for splitting and careful screening of potential SLT recipients is warranted. Furthermore, the logistic background of the splitting procedure as well as the organ allocation policy must be adapted to further increase the number and the safety of SLT. Under defined circumstances, in selected patients and at experienced transplant centers, SLT outcomes can be similar to those obtained in full organ LT. Thus, SLT is an important tool to reduce the donor organ shortage and waitlist mortality, especially for pediatric patients and small adults. The present review gives an overview of technical aspects, current developments, and clinical outcomes of SLT.

Acute cellular rejection treatment outcomes stratified by Banff grade in pediatric kidney transplant.

There are limited data to guide optimal treatment strategies for acute cellular rejection (ACR) based on Banff grade for pediatric kidney transplant recipients. This report reviews a large pediatric transplant center's experience with ACR. A retrospective analysis of pediatric kidney transplant recipients at our center from 2007 to 2014 was performed. Primary outcomes were incidence of graft failure and graft function one year following ACR based on Banff grade and treatment received. A total of 204 patients were reviewed, of which 65 received rejection treatment with either an oral steroid cycle (n=16), intravenous steroid pulse (n=28), or anti-thymocyte globulin (rATG, n=21). Overall, patients received rATG for treatment of more severe rejection associated with impaired graft function and as a group experienced statistically significant improvements in eGFR over the year following treatment, though most did not regain baseline graft function. Our data suggest that rATG is partially effective in treating ACR, but our study was underpowered to determine the effect of different treatments based on Banff grade. Since there is limited literature to guide clinical treatment of ACR in children, large transplant centers should collaborate to evaluate outcomes and establish evidence-based practice.

Patients prioritize waitlist over posttransplant outcomes when evaluating kidney transplant centers.

Factors that patients value when choosing a transplant center have not been well studied. In order to guide the improvement of patient-facing materials, we conducted an anonymous electronic survey of patients that assessed the relative importance of patient experience, practical considerations, transplant center reputation, center experience, and waitlist when selecting a transplant center. A total of 409 respondents completed the survey, of whom 68% were kidney transplant recipients and 32% had chronic kidney disease or were on dialysis. Participants had mean age 56±12years and were predominantly female (61%), white (79%), and had an associate's degree or higher (68%). Participants most often prioritized waitlist when evaluating transplant centers (transplanted 26%, chronic kidney disease 40%), and waitlist was almost twice as likely as outcomes to be ranked most important (30% vs 17%). Education level and transplant status were significantly associated with factors used for center prioritization. Waitlisted respondents most commonly (48%) relied on physicians for information when selecting a center, while a minority cited transplant-specific organizations. In order to improve shared decision-making, materials outlining center-specific waitlist features should be prioritized. Novel patient-oriented metrics for measuring transplant center quality that align with patient priorities must be explored.

Life-threatening or nearly life-threatening complications in living liver donors.

To determine the relationship between a transplant center's experience and life-threatening or nearly life-threatening complications during living donor hepatectomy (LDH). The medical records of 1140 patients who underwent LDH were analyzed. To determine the relationship between life-threatening complications and a transplant center's experience, the following comparisons between LDH cases were performed: first 100 vs subsequent 100; first 100 vs subsequent 1040; first 200 vs subsequent 940; right hepatectomy vs left hepatectomy; and first 5years of experience vs subsequent 5years. A total of 36 life-threatening or nearly life-threatening complications developed in 34 of 1140 (2.98%) healthy individuals undergoing LDH. Of these, 5 occurred intraoperatively, 26 within 1month, and 5 beyond 1month. The most common complications were biliary problems and postoperative bleeding. None of the donors died at follow-up. One donor underwent deceased donor liver transplantation (DDLT) for severe hepatic failure. Only 2 comparisons were significantly different with regard to life-threatening complications: the first 100 vs the subsequent 1040 (P=.03) and the first 200 vs the subsequent 940 (P=.01). This study indicates that the incidence of life-threatening or nearly life-threatening complications are reduced by increased center experience (>200 LDHs).

Sleeve gastrectomy decreases the incidence of metabolic syndrome in obese post-liver transplant patients

Background: Metabolic syndrome (MS) after liver transplant poses a significant heath burden, with one-third of post liver transplant (OLT) patients developing recurrent non-alcoholic steatohepatitis (NASH). Bariatric surgery improves MS and NASH in the general population, however, this benefit is unknown in OLT patients. We aim to evaluate the efficacy of laparoscopic sleeve gastrectomy (LSG) as treatment of MS following OLT. Methods: A retrospective review of a single high-volume transplant center experience was performed. Over a 2-year period, 16 obese patients with a history of OLT were referred to our institution's metabolic surgery clinic. Of these, 11 patients underwent LSG. Patient demographics, comorbidities, body mass index (BMI), and 30-day complications were analyzed. Results: Median patient age was 61 years, pre-OLT BMI was 42.7 kg/m2 , and BMI prior to LSG was 40.0 kg/m2 . Median interval from transplant to LSG was 2.7 years and median follow-up after LSG was 375 days. For patients with 1 year follow-up (n = 7), median BMI was 33.3 kg/m2 , mean percent excess weight loss was 48.0% ± 21.0% and mean percent total body weight loss was 23.4% ± 8.9%. Incidence of MS was reduced by 75%. A 53% reduction in anti-hypertensive medications was seen and 2 of 3 patients discontinued insulin completely. While one patient required two units of blood post-operatively, there were no other complications. Patients without a LSG (n = 5) did not experience weight loss with a medical weight loss program (median pre-OLT BMI 33.7 kg/m2 , median post-OLT BMI 40.3 kg/m2 , and most recent median BMI 39.7 kg/m2 ) and none achieved resolution of MS. Conclusion: LSG is safe and effective for the management of obesity and metabolic syndrome in the post OLT population. By reducing the prevalence of MS after OLT, LSG may decrease the incidence of recurrent NASH.

Fifteen-Year Analysis of Deceased Kidney Donation: A Single Transplant Center Experience in a Region of Northern Italy.

BackgroundThe rising number of patients on waiting lists for kidney transplant and the shortage of available organs has intensified efforts to increase the number of potential donors.Material/MethodsThis study investigated changes in clinical parameters among potential deceased donors in the 15-year period between 1999 and 2013 and their impact on transplantation procedure and outcomes. A total of 1634 potential deceased donors were examined and divided into 2 groups: 707 of them identified from 1999 to 2005 (Group A), and 927 from 2006 to 2013 (Group B).ResultsThe comparison between the potential donors in Group A vs. Group B revealed an increase over time in donor age (54.6±17.2 vs. 58.8±16.3, p<0.001), a reduction in the percentage of standard donors (52.3% vs. 39.8%, p<0.001), a broader utilization of organs from expanded criteria donors, and a greater number of comorbidities, particularly cardiovascular disease and dyslipidemia. However, renal function parameters and the bioptic scores did not change significantly over the years.ConclusionsThese results suggest the usefulness of strategies to increase the number of potential donors suitable for organ donation, especially among elderly and marginal donors.

Avances en la selección de donantes para el trasplante pulmonar

La obtención de donantes pulmonares válidos continúa siendo un reto en el trasplante pulmonar. En los centros trasplantadores con larga trayectoria, una de las opciones que ha permitido aumentar el número de trasplantes pulmonares por año, ha sido la extensión de los criterios de aceptabilidad para los donantes. En este artículo se hace un repaso minucioso de cada criterio por separado y de la posible influencia en los resultados del trasplante a corto y largo plazo; Igualmente, se revisan los datos actuales de donación y trasplante en España.

Outcomes from Autologous Hematopoietic Cell Transplantation versus Chemotherapy Alone for the Management of Light Chain Amyloidosis

Light chain amyloidosis (AL) results in tissue deposition of misfolded proteins, causing organ dysfunction. In an era of modern therapies, such as bortezomib, reassessment of the benefit of autologous hematopoietic cell transplantation (AHCT) should be considered. In this study, we compared outcomes between patients with AL receiving chemotherapy alone (CT) and those undergoing AHCT. Seventy-four patients with AL were analyzed retrospectively. Two cohorts of patients were studied, those receiving CT (n = 31) and those undergoing AHCT (n = 43). Of the 43 patients in the AHCT cohort, 29 received induction chemotherapy before AHCT, whereas 14 proceeded straight to AHCT without induction therapy. Compared with the CT cohort, patients in the AHCT cohort were younger and had higher ejection fractions, lower brain natriuretic peptide levels, and more severe proteinuria. The majority (87%) of patients in the CT cohort received bortezomib-based treatment. Transplantation-related mortality (TRM) was 7%. Patients receiving AHCT were more likely to achieve complete or very good partial response (P = .048). The median progression-free survival (PFS) and overall survival (OS) were superior in the AHCT cohort (not reached versus 9 months; P < .01 and 74 months versus 8 months; P = .03, respectively). Multivariable analysis demonstrated that improved PFS (hazard ratio, 3.86; 95% confidence interval [CI] 1.3 to 11.5; P = .02) and OS (hazard ratio, 5.6; 95% CI, 1.9 to 16; P < .001) were associated with use of AHCT compared with CT. Patients in the AHCT cohort had deeper and longer durations of response, with superior PFS and OS, compared with those in the CT cohort. Despite the limitations of this study, AHCT should be considered for eligible patients with AL at experienced transplantation centers that can offer this therapy with a low risk of TRM.

Kidney transplantation for end-stage renal disease in lupus nephritis, a very safe procedure: a single Latin American transplant center experience.

Background Lupus nephritis (LN) is one of the most frequent complications of SLE and occurs in up to 50% of cases depending on the studied population. Of these, approximately 20% progress to end-stage renal disease (ESRD), with the treatment of choice being a kidney transplant. Objective The objective of this study was to describe the clinical outcome of patients transplanted due to LN, compared with patients transplanted for other causes, in a Latin American population from the Fundación Valle del Lili in Cali, Colombia. Methods Observational, retrospective case study with controls matched by age, sex and type of donor in a single center between 1996 and 2014. Results Sixty-five kidney transplants were performed in patients with LN and ESRD. The survival of patients with LN was 98% at 1, 10 and 15 years ( p = .99). For controls by age and sex, survival was also 98% at 15 years post-transplant, and for controls by donor, the survival rate was 100% at 5 years and 98% at 15 years. Graft survival in patients with LN to 1, 5 and 15 years was 92%, 83% and 71%, respectively; for controls by age and sex, it was 90%, 84% and 64%, respectively, and for the controls by donor, it was 89%, 86% and 79%, respectively ( p = .7718). There were no statistically significant differences found in the cumulative incidence of acute graft rejection in the first year, but it was found that acute rejection is a factor that relates to the loss of function of the renal graft ( p = .032). Of the patients transplanted for LN, two (3.1%) experienced a recurrence of the disease. One patient died after a diagnosis of recurrence of LN due to an infection. Conclusions Kidney transplantation is a good option for patients with ESRD due to LN. In this Hispanic population, the survival of patients, graft survival, and cumulative incidence of graft rejection are not different from those of other transplanted patients. In addition, recurrence of LN was rare, showing the benefits of renal transplantation in LN patients with ESRD.

Lung transplant: Candidates for referral and the waiting list.

For patients with end-stage lung diseases, lung transplant may significantly extend survival and improve quality of life. Identifying patients that are likely to benefit from a lung transplant is essential to positive outcomes and to maximizing life expectancy for each patient. Prompt referral to and communication with an experienced lung transplant center allows for timely completion of the formal evaluation of candidacy and placement on the organ transplant waiting list. This article summarizes the selection criteria for lung transplant candidates, including when physicians should refer patients to transplant centers for evaluation and placement on the lung transplant waiting list.

Use of Bone Marrow or Peripheral Blood Stem Cell Grafts in Non T Cell Depleted Haploidentical Transplants Using Post-Transplant Cyclophosphamide, an ALWP-EBMT Analysis

▪The use of mobilized peripheral blood (PB) as stem cell source in allogeneic stem cell transplantation (HSCT) from sibling or unrelated donors is associated with higher incidence of chronic graft versus host disease (GVHD) as compared to HSCT with bone marrow (BM). The reported incidence of GVHD in the haploidentical transplants with PT-Cy with BM grafts is low, while GVHD incidence using PB grafts varied between studies between 30% to 40% in single center reports.With the aim to analyze the effect of stem cell (SC) source in the setting of non T cell depleted haploidentical transplant using post-transplant Cyclophosphamide (PT-Cy), we analyzed patients (pts) transplanted for AML or ALL in first or second complete remission (CR) and reported to the EBMT from 2010 to 2014.Four hundred fifty one pts were analyzed, the majority of the pts in both groups were transplanted for AML (73%) in CR1 (67%). BM was the source of SC for 260 pts and PB for 191. Median follow up was longer for pts receiving BM (22.8 vs 18.3 months) and those pts were more likely transplanted with a MAC (61% vs 49%, p=0.008). All pts received PT-Cy as GVHD prophylaxis and prophylaxis was mainly in combination to calcineurin inhibitor and MMF, according to transplant center policy. ATG use was not different for the 2 groups (5% vs 7%, p=0.41).Overall OS, LFS and GRF at 2 year were 55%, 51% and 43%. CI of grade II-IV acute GVHD, chronic GVHD, NRM and Relapse at 2 year were 18%, 35%, 23% and 24%, respectively.Pts transplanted with BM had a longer time to neutrophil engraftment (18 vs 17 days, p= <0.001). In the univariate analysis pts transplanted with BM had a lower incidence of grade II-IV and grade III-IV acute GVHD (12% vs 27%, p=<0.01; and 3%% vs 8%, p=<0.01, respectively). No difference in chronic GVHD (36% vs 32%, p=0.28) was reported according to the SC source (PB vs BM), nor in relapse (26% vs 22%, p=0.38) and NRM (23% vs 23%, p=0.60).At 2 year LFS was 49% vs 54%, p=074 and GRFS was 44% and 42%, p=0.59, for pts receiving BM and PB, respectively. LFS was 53% and 47% (p=0.31) for pts transplanted for AML and ALL, and 56% and 46% (p=0.004) for MAC vs RIC.In the multivariate analysis adjusted for age, diagnosis, disease status, CMV serostatus, conditioning regimen, center effect and SC source, the use of PB was the sole factor associated with an increased risk of grade II-IV acute GVHD (HR 2.2, 95%CI 1.27-3.9, p=0.005). The type of SC (PB vs BM) was not significant associated with grade III-IV aGVHD (HR 2.5, 95%CI 0.9-7.3, p=0.07), cGVHD (HR 1.0, 95%CI 0.57-1.9, p=0.88), relapse (HR 0.7, 95%CI 0.51-1.15, p=0.21), NRM (HR 0.80, 95%CI 0.49-1.32, p=0.4), GRFS (HR 0.90, 95%CI 0.65-1.25, p=0.56), LFS (HR 0.73, 95%CI 0.52-1.04, p=0.08) and OS (HR 0.79, 95%CI 0.54-1.15, p=0.23).For LFS and OS, the use of RIC regimen was the only factor associated with a higher risk of treatment failure, (LFS: HR 1.39, 95%CI 1.01-1.93, p=0.04; OS: HR 1.5, 95%CI 1.06-2.12, p=0.02) and higher risk of relapse (HR 1.61, 95%CI 1.06-2.44, p=0.02).Finally, a center effect was found to be significant for NRM, LFS, GRFS, OS and cGVHD , and entered a frailty variable in the multivariate model.In conclusion, our study indicates that in patients with acute leukemia in first or second CR receiving haploidentical transplant with PT-Cy, the outcomes according to the use of PB or BM are not different. The ultimate choice depends on transplant center experience and policy. DisclosuresBacigalupo:PIERRE FABRE: Speakers Bureau; SANOFI: Speakers Bureau. Ciceri:MolMed SpA: Consultancy.

Assessment of Portopulmonary Hypertension in Patients Awaiting Liver Transplant – A Tertiary Hospital Transplant Centre Experience

Assessment of Portopulmonary Hypertension in Patients Awaiting Liver Transplant – A Tertiary Hospital Transplant Centre Experience

Perioperative bleeding in patients undergoing liver transplantation.

Liver transplantation (LT) remains one of the most challenging surgical procedures. For many years uncontrolled bleeding and catastrophic haemorrhages were one of the major causes of perioperative mortality and morbidity. During the past fifty years or so, significant progress in surgical techniques and perioperative management has led to a marked change in transfusion practice over time, where up to 79.6% of LTs in experienced transplant centers are performed without any blood product transfusion. Despite this, perioperative bleeding and transfusion requirements remain potent predictors of patient's mortality, as well as postoperative complications and graft survival. The major impact of blood product transfusion on LT recipient outcomes implies that all patients on waiting lists should be carefully screened for the presence of risk factors of perioperative bleeding. Although multiple predictors of transfusion requirements during LT have been identified, no predictive model validated across centers has been constructed. The most suitable strategies to reduce intraoperative blood loss in this group should be employed on a case-to-case basis. This paper aims to summarize the most up-to-date evidence in the management of haemostasis in LT recipients.