Liver Transplant | ScienceGate

Background Patients with end-stage liver disease frequently incur large-volume blood loss during liver transplantation associated with mechanical factors, preexisting coagulopathy, and intraoperative fibrinolysis. Methods Between April 1992 and May 1994, the authors of this double-blind, randomized, placebo-controlled study examined the effect of high-dose tranexamic acid (maximum of 20 g) on blood loss and blood product requirements in patients undergoing primary isolated orthotopic liver transplantation. Primary outcome measures were volume of blood loss (intraoperative blood loss and postoperative drainage) and erythrocyte, plasma, platelet, and cryoprecipitate use during surgery and the first 24 h of intensive care unit stay. Results Patients receiving tranexamic acid (n = 25) had less intraoperative blood loss (median, 4.3 l; interquartile range, 2.5 to 7.9; P = 0.006) compared with the placebo group (n = 20; median, 8 l; interquartile range, 5 to 15.8), and reduced intraoperative plasma, platelet, and cryoprecipitate requirements. Median perioperative erythrocyte use was 9 units (interquantile range, 4 to 14 units) in patients receiving tranexamic acid and 13 units (interquantile range, 7.5 to 31 units) in controls (P = 0.03). Total perioperative donor exposure was 20.5 units (interquantile range, 16 to 41 units) in patients receiving tranexamic acid and 43.5 units (interquantile range, 29.5 to 79 units) in controls (P = 0.003). Results for postoperative wound drainage were similar. Hospital stay and need for retransplantation were comparable in both groups. No patient in either group showed clinical evidence of hepatic artery or portal venous thrombosis within 1 month of transplantation. Conclusions High-dose tranexamic acid significantly reduces intraoperative blood loss and perioperative donor exposure in patients with end-stage parenchymal liver disease who are undergoing orthotopic liver transplantation, with marked reductions in platelet and cryoprecipitate requirements.

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Preoperative Trapped Lung Is Associated With Increased Mortality After Orthotopic Liver Transplantation

Progress in Transplantation ◽

10.1177/1526924820978604 ◽

2020 ◽

pp. 152692482097860

Author(s):

Kathryn H. Melamed ◽

David Dai ◽

Natasha Cuk ◽

Daniela Markovic ◽

Robert Follett ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Liver Transplant ◽

Orthotopic Liver Transplantation ◽

Meld Score ◽

Transplant Recipients ◽

End Stage Liver Disease ◽

Trapped Lung ◽

End Stage ◽

Liver Transplant Recipients

Introduction: Trapped lung, characterized by atelectatic lung unable to reexpand and fill the thoracic cavity due to a restricting fibrous visceral pleural peel, is occasionally seen in patients with end-stage liver disease complicated by hepatic hydrothorax. Limited data suggest that trapped lung prior to orthotopic liver transplantation may be associated with poor outcomes. Research Question: What is the clinical significance of trapped lung in patients receiving orthotopic liver transplantation? Design: We performed a retrospective analysis of patients who underwent liver transplantation over an 8-year period. Baseline clinical characteristics and postoperative outcomes of adult patients with trapped lung were analyzed and compared to the overall cohort of liver transplant recipients and controls matched 3:1 based on age, sex, Model for End-Stage Liver Disease (MELD) score, and presence of pleural effusion. Results: Of the 1193 patients who underwent liver transplantation, we identified 20 patients (1.68%) with trapped lung. The probability of 1 and 2-year survival were 75.0% and 57.1%, compared to 85.6% and 80.4% (p = 0.02) in all liver transplant recipients and 87.9% and 81.1% (p = 0.03) in matched controls respectively. Patients with trapped lung had a longer hospital length of stay compared to the total liver transplant population (geometric mean 54.9 ± 8.4 vs. 27.2 ± 0.7 days, p ≤ 0.001), when adjusted for age and MELD score. Discussion: Patients with trapped prior to orthotopic liver transplantation have increased probability of mortality as well as increased health care utilization. This is a small retrospective analysis, and further prospective investigation is warranted.

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Chemoprophylaxis Use and Risk of Venous Thromboembolism and Death in Adult Patients following Orthotopic Liver Transplantation

Journal of Pharmacy Practice ◽

10.1177/0897190014566304 ◽

2015 ◽

Vol 29 (3) ◽

pp. 218-223 ◽

Cited By ~ 3

Author(s):

Brianna R. Alexander ◽

Abigail D. Antigua ◽

Amy F. Rosenberg ◽

Lawrence J. Caruso ◽

Stacy A. Voils ◽

...

Keyword(s):

Liver Transplantation ◽

Venous Thromboembolism ◽

Liver Transplant ◽

Orthotopic Liver Transplantation ◽

Retrospective Chart Review ◽

Positive Association ◽

Significant Positive Association ◽

Vte Prophylaxis ◽

End Stage ◽

Liver Transplant Recipients

Background: Coagulation abnormalities in end-stage liver disease may preclude patients from receiving venous thromboembolism (VTE) prophylaxis immediately following orthotopic liver transplantation. Methods: To identify risk factors for VTE and death following liver transplantation, a retrospective chart review was conducted in adult liver transplant recipients from January 1, 2001, to October 1, 2011. Results: In 716 transplantations in 701 patients, the overall incidence of VTE was 2.1%. The incidence was 3.6% in patients who received chemoprophylaxis compared to 1.4% in those without chemoprophylaxis ( P = .06). Most patients (69.5%) did not receive chemoprophylaxis postsurgery during their hospitalization. Multivariate logistic regression modeling revealed no association between the use of chemoprophylaxis (adjusted odds ratio [OR] 1.5 [0.45-4.7], P = .53) and VTE. A significant positive association was observed between the use of chemoprophylaxis (adjusted OR 3.2 [1.3-8.0], P = .01) and death. Conclusion: Use of chemoprophylaxis and increasing amounts of blood products following orthotopic liver transplant was associated with increased mortality. A significant positive association was observed between blood product administration and VTE, while chemoprophylaxis use was not significantly associated with VTE. Larger prospective studies are necessary to further examine the significance of this finding.

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Responsibility and Priority in Liver Transplantation

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180108090051 ◽

2009 ◽

Vol 18 (1) ◽

pp. 23-35 ◽

Cited By ~ 12

Author(s):

WALTER GLANNON

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Liver Failure ◽

Liver Transplant ◽

End Stage Renal Disease ◽

Liver Transplants ◽

Lower Priority ◽

End Stage Liver Disease ◽

Stage Renal Disease ◽

End Stage

In a provocative 1991 paper, Alvin Moss and Mark Siegler argued that it may be fair to give individuals with alcohol-related end-stage liver disease (ARESLD) lower priority for a liver transplant than those who develop end-stage liver disease (ESLD) from other factors. Like other organs, there is a substantial gap between the available livers for transplantation and the number of people who need liver transplants. Yet, unlike those with end-stage renal disease, who can survive for some time on dialysis before receiving a kidney transplant, those with liver failure will die without a liver transplant.

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Orthotopic liver transplantation with poor neurologic outcome in valproate-associated liver failure: a need for critical risk-benefit appraisal in the use of valproate

Transplantation Proceedings ◽

10.1016/s0041-1345(99)00936-7 ◽

2000 ◽

Vol 32 (1) ◽

pp. 200-203 ◽

Cited By ~ 20

Author(s):

M.A Thomson ◽

S Lynch ◽

R Strong ◽

R.W Shepherd ◽

W Marsh

Keyword(s):

Liver Transplantation ◽

Liver Failure ◽

Orthotopic Liver Transplantation ◽

Neurologic Outcome

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Auxiliary Partial Orthotopic Liver Transplantation for Acute Liver Failure: Not Supportive Enough?

Indian Journal of Surgery ◽

10.1007/s12262-021-02925-9 ◽

2021 ◽

Author(s):

S. T. Binoj ◽

Johns Shaji Mathew ◽

M. Abdul Razak ◽

Krishnanunni Nair ◽

Shweta Mallick ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Failure ◽

Acute Liver Failure ◽

Orthotopic Liver Transplantation

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HIV and Liver transplantation: The British Columbia Experience, 2004 to 2013

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2014/373898 ◽

2014 ◽

Vol 25 (3) ◽

pp. 159-162 ◽

Cited By ~ 5

Author(s):

Clara Tan-Tam ◽

Pamela Liao ◽

Julio S Montaner ◽

Mark W Hull ◽

Charles H Scudamore ◽

...

Keyword(s):

British Columbia ◽

Liver Transplantation ◽

Hepatitis C Virus ◽

Liver Disease ◽

Hepatitis C ◽

Liver Transplant ◽

Clinical Outcomes ◽

Disease Status ◽

Transplant Program ◽

End Stage

BACKGROUND: The demand for definitive management of end-stage organ disease in HIV-infected Canadians is growing. Until recently, despite international evidence of good clinical outcomes, HIV-infected Canadians with end-stage liver disease were ineligible for transplantation, except in British Columbia (BC), where the liver transplant program of BC Transplant has accepted these patients for referral, assessment, listing and provision of liver allograft. There is a need to evaluate the experience in BC to determine the issues surrounding liver transplantation in HIV-infected patients.METHODS: The present study was a chart review of 28 HIV-infected patients who were referred to BC Transplant for liver transplantation between 2004 and 2013. Data regarding HIV and liver disease status, initial transplant assessment and clinical outcomes were collected.RESULTS: Most patients were BC residents and were assessed by the multidisciplinary team at the BC clinic. The majority had undetectable HIV viral loads, were receiving antiretroviral treatments and were infected with hepatitis C virus (n=16). The most common comorbidities were anxiety and mood disorders (n=4), and hemophilia (n=4). Of the patients eligible for transplantation, four were transplanted for autoimmune hepatitis (5.67 years post-transplant), nonalcoholic steatohepatitis (2.33 years), hepatitis C virus (2.25 years) and hepatitis B-delta virus coinfection (recent transplant). One patient died from acute renal failure while waiting for transplantation. Ten patients died during preassessment and 10 were unsuitable transplant candidates. The most common reason for unsuitability was stable disease not requiring transplantation (n=4).CONCLUSIONS: To date, interdisciplinary care and careful selection of patients have resulted in successful outcomes including the longest living HIV-infected post-liver transplant recipient in Canada.

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