1
|
Fiala A, Breitkopf R, Sinner B, Mathis S, Martini J. [Anesthesia for organ transplant patients]. DIE ANAESTHESIOLOGIE 2023; 72:773-783. [PMID: 37874343 PMCID: PMC10615924 DOI: 10.1007/s00101-023-01332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 10/25/2023]
Abstract
Organ transplant patients who must undergo nontransplant surgical interventions can be challenging for the anesthesiologists in charge. On the one hand, it is important to carefully monitor the graft function in the perioperative period with respect to the occurrence of a possible rejection reaction. On the other hand, the ongoing immunosuppression may have to be adapted to the perioperative requirements in terms of the active substance and the route of administration, the resulting increased risk of infection and possible side effects (e.g., myelosuppression, nephrotoxicity and impairment of wound healing) must be included in the perioperative treatment concept. Furthermore, possible persistent comorbidities of the underlying disease and physiological peculiarities as a result of the organ transplantation must be taken into account. Support can be obtained from the expertise of the respective transplantation center.
Collapse
Affiliation(s)
- Anna Fiala
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Robert Breitkopf
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - Barbara Sinner
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Simon Mathis
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Judith Martini
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| |
Collapse
|
2
|
McPartland KJ, Pomposelli JJ. Update on Immunosuppressive Drugs Used in Solid-Organ Transplantation and Their Nutrition Implications. Nutr Clin Pract 2017; 22:467-73. [PMID: 17906270 DOI: 10.1177/0115426507022005467] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The success of solid organ transplantation rests heavily on the major advances in immunosuppressive therapy. The early years of organ transplantation were plagued with high failure rates and frequent episodes of acute rejection. With the introduction of improved immunosuppressive agents, successful organ transplantation has become the norm. The emphasis of immunosuppressive therapy has shifted from preventing rejection to balancing acceptable rates of rejection with moderation in adverse effects of the immunosuppressive agents. Among the many possible adverse effects of immunosuppressive therapy is the potential for these agents to affect the nutrition status of the transplant recipient. Given the fact that many patients undergoing transplantation are catabolic and nutritionally vulnerable, it is particularly important for those involved in the care of these patients to be familiar with the nutrition implications of immunosuppressive drugs. In this article, we review the different classes of immunosuppressive medications used in transplantation and emphasize their interactions with the nutrition status of the transplant recipient.
Collapse
Affiliation(s)
- Kenneth J McPartland
- Division of Hepatobiliary Surgery and Liver Transplantation, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA
| | | |
Collapse
|
3
|
Guerrero-Tinoco GA, Villafañe-Bermúdez DR, Vélez-Echeverri C. Inmunosupresores y principales complicaciones en el trasplante renal pediátrico. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n1a05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
4
|
de'Angelis N, Esposito F, Memeo R, Lizzi V, Martìnez-Pérez A, Landi F, Genova P, Catena F, Brunetti F, Azoulay D. Emergency abdominal surgery after solid organ transplantation: a systematic review. World J Emerg Surg 2016; 11:43. [PMID: 27582783 PMCID: PMC5006611 DOI: 10.1186/s13017-016-0101-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 08/17/2016] [Indexed: 02/07/2023] Open
Abstract
AIMS Due to the increasing number of solid organs transplantations, emergency abdominal surgery in transplanted patients is becoming a relevant challenge for the general surgeon. The aim of this systematic review of the literature is to analyze morbidity and mortality of emergency abdominal surgery performed in transplanted patients for graft-unrelated surgical problems. METHODS The literature search was performed on online databases with the time limit 1990-2015. Studies describing all types of emergency abdominal surgery in solid organ transplanted patients were retrieved for evaluation. RESULTS Thirty-nine case series published between 1996 and 2015 met the inclusion criteria and were selected for the systematic review. Overall, they included 71671 transplanted patients, of which 1761 (2.5 %) underwent emergency abdominal surgery. The transplanted organs were the heart in 65.8 % of patients, the lung in 22.1 %, the kidney in 9.5 %, and the liver in 2.6 %. The mean patients' age at the time of the emergency abdominal surgery was 49.4 ± 7.4 years, and the median time from transplantation to emergency surgery was 2.4 years (range 0.1-20). Indications for emergency abdominal surgery were: gallbladder diseases (80.3 %), gastrointestinal perforations (9.2 %), complicated diverticulitis (6.2 %), small bowel obstructions (2 %), and appendicitis (2 %). The overall mortality was 5.5 % (range 0-17.5 %). The morbidity rate varied from 13.6 % for gallbladder diseases to 32.7 % for complicated diverticulitis. Most of the time, the immunosuppressive therapy was maintained unmodified postoperatively. CONCLUSIONS Emergency abdominal surgery in transplanted patients is not a rare event. Although associated with relevant mortality and morbidity, a prompt and appropriate surgery can lead to satisfactory results if performed taking into account the patient's immunosuppression therapy and hemodynamic stability.
Collapse
Affiliation(s)
- Nicola de'Angelis
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Francesco Esposito
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Riccardo Memeo
- Department of Hepato-biliary and Pancreatic Surgery, Nouvel Hôpital Civil, Strasbourg, France
| | - Vincenzo Lizzi
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Aleix Martìnez-Pérez
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Filippo Landi
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Pietro Genova
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Fausto Catena
- Department of Emergency Surgery, University Hospital "Ospedale Maggiore" of Parma, Parma, Italy
| | - Francesco Brunetti
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Daniel Azoulay
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, "Henri Mondor" University Hospital, Université Paris Est - UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| |
Collapse
|
5
|
Perosa M, Crescentini F, Antunes I, Rangel EB, Rangel E, Guimaro M, de Sá JR, Carneiro A, Yonezawa E, Genzini T. Pancreas transplantation alone in children: a case report. Clin Transplant 2009; 23:964-7. [PMID: 19719729 DOI: 10.1111/j.1399-0012.2009.01058.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pancreas transplantation (PT) is a relatively uncommon therapy for non-uremic type 1 diabetes, as the severity of diabetes must warrant the risk of immunosuppression. In pediatric diabetic patients, who are less likely to display uremia because of the duration of diabetes, there is very little experience with pancreas transplantation alone (PTA). This report describes a 13-yr-old male PTA recipient. This patient was initially diagnosed with type 1 diabetes mellitus at the age of four yr. Following a multidisciplinary evaluation, PTA was found to be indicated based on a history of severe labile diabetes and hypoglycemic unawareness resulting in frequent episodes of hypoglycemia and hospital admissions. Because of the failure of medical management of the patient's diabetes, a whole organ bladder and systemic drained PTA was performed. Immunosuppression included thymoglobulin, tacrolimus, mycophenolate mofetil, and steroids. Early outcome was uneventful and patient was discharged 12 d after surgery normoglycemic and insulin-free. An episode of acute rejection (Maryland grade II) 20-d post-transplant was successfully treated with corticosteroids. A second and more severe episode of rejection (Maryland grade IV) occurred 13 months post-transplant, requiring treatment with thymoglobulin and conversion from steroid to sirolimus. On tacrolimus, sirolimus, and mycophenolic acid, he remains euglycemic and insulin-free 38 months after PTA. His quality-of-life is judged to be superior to his insulin dependent state prior to transplantation. According to the medical literature, this is the youngest patient ever to undergo PTA.
Collapse
Affiliation(s)
- Marcelo Perosa
- Pancreas Transplant Service, Albert Einstein Hospital, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | | |
Collapse
|