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Smith NK, Zerillo J, Kim SJ, Efune GE, Wang C, Pai SL, Chadha R, Kor TM, Wetzel DR, Hall MA, Burton KK, Fukazawa K, Hill B, Spad MA, Wax DB, Lin HM, Liu X, Odeh J, Torsher L, Kindscher JD, Mandell MS, Sakai T, DeMaria S. Intraoperative Cardiac Arrest During Adult Liver Transplantation: Incidence and Risk Factor Analysis From 7 Academic Centers in the United States. Anesth Analg 2021; 132:130-139. [PMID: 32167977 DOI: 10.1213/ane.0000000000004734] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intraoperative cardiac arrest (ICA) has a reported frequency of 1 in 10,000 anesthetics but has a much higher estimated incidence in orthotopic liver transplantation (OLT). Single-center studies of ICA in OLT are limited by small sample size that prohibits multivariable regression analysis of risks. METHODS Utilizing data from 7 academic medical centers, we performed a retrospective, observational study of 5296 adult liver transplant recipients (18-80 years old) between 2000 and 2017 to identify the rate of ICA, associated risk factors, and outcomes. RESULTS ICA occurred in 196 cases (3.7% 95% confidence interval [CI], 3.2-4.2) and mortality occurred in 62 patients (1.2%). The intraoperative mortality rate was 31.6% in patients who experienced ICA. In a multivariable generalized linear mixed model, ICA was associated with body mass index (BMI) <20 (odds ratio [OR]: 2.04, 95% CI, 1.05-3.98; P = .0386), BMI ≥40 (2.16 [1.12-4.19]; P = .022), Model for End-Stage Liver Disease (MELD) score: (MELD 30-39: 1.75 [1.09-2.79], P = .02; MELD ≥40: 2.73 [1.53-4.85], P = .001), postreperfusion syndrome (PRS) (3.83 [2.75-5.34], P < .001), living donors (2.13 [1.16-3.89], P = .014), and reoperation (1.87 [1.13-3.11], P = .015). Overall 30-day and 1-year mortality were 4.18% and 11.0%, respectively. After ICA, 30-day and 1-year mortality were 43.9% and 52%, respectively, compared to 2.6% and 9.3% without ICA. CONCLUSIONS We established a 3.7% incidence of ICA and a 1.2% incidence of intraoperative mortality in liver transplantation and confirmed previously identified risk factors for ICA including BMI, MELD score, PRS, and reoperation and identified new risk factors including living donor and length of surgery in this multicenter retrospective cohort. ICA, while rare, is associated with high intraoperative mortality, and future research must focus on therapy to reduce the incidence of ICA.
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Affiliation(s)
- Natalie K Smith
- From the Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Jeron Zerillo
- From the Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Sang Jo Kim
- Department of Anesthesiology, Hospital for Special Surgery, New York City, New York
| | - Guy E Efune
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cynthia Wang
- Department of Anesthesiology, Greater Los Angeles VA Healthcare System, Los Angeles, California
| | - Sher-Lu Pai
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida
| | - Ryan Chadha
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida
| | - Todd M Kor
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - David R Wetzel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael A Hall
- Department of Anesthesiology, Christiana Care Health System, Newark, Delaware
| | - Kristen K Burton
- Department of Anesthesiology and Critical Care, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kyota Fukazawa
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Bryan Hill
- Department of Anesthesiology, The Ohio State University, Columbus, Ohio
| | | | - David B Wax
- From the Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Hung-Mo Lin
- Department of Population Health Science and Policy, The Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Xiaoyu Liu
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Jaffer Odeh
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Laurence Torsher
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - James D Kindscher
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas
| | - M Susan Mandell
- Department of Anesthesiology, University of Colorado Hospital, Aurora, Colorado.,The Center for Perioperative & Pain Quality, Safety and Outcomes-PPQiSO, University of Washington Medical Center, Seattle, Washington
| | - Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samuel DeMaria
- From the Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai, New York City, New York
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Arantes RM, Nacif LS, Pinheiro RS, Rocha-Santos V, de Martino RB, Waisberg DR, Pantanali CAR, Fortunato A, Lima MR, Ducatti L, Haddad LBDP, Ejzenberg D, Galvão FH, Andraus W, Carneiro-D'Albuquerque L. Novel Technique in a Sheep Model of Uterine Transplantation. Transplant Proc 2020; 52:1399-1401. [PMID: 32276834 DOI: 10.1016/j.transproceed.2020.02.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 02/07/2020] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Uterine transplantation (UTx) is a surgical therapeutic modality designed for the treatment of patients with exclusive uterine factor infertility. Experimental models are paramount to study this transplant modality, and as the ewes' uteri are very similar to that of humans, they are frequently used with this purpose. The aim of this study is to describe a novel technical variation for UTx in sheep. METHODS This study was conducted at Laboratory of Medical Investigation 37 of the University of São Paulo School of Medicine in São Paulo, Brazil, and was approved by the Ethics Committee of Animal Use of the university. We used 3 adult female sheep that weighed approximately 45 kg and were not pregnant. We performed the technique of uterine autotransplantation with a novel technical variation that we called sequential vascularization: first, we performed the right uterine artery and vein anastomoses, after which the uterine graft was vascularized, and then the contralateral vascular anastomoses were performed. CONCLUSION We described 3 successful uterine autotransplants in sheep models with sequential vascularization. This variation technique will probably allow warm ischemia time in UTx to significantly decrease.
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Affiliation(s)
- Rubens Macedo Arantes
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.
| | - Lucas Souto Nacif
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rafael Soares Pinheiro
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Vinicius Rocha-Santos
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rodrigo Bronze de Martino
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Daniel Reis Waisberg
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Carlos Andres Rodriguez Pantanali
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Allana Fortunato
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Marisa Rafaela Lima
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Liliana Ducatti
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luciana Bertocco de Paiva Haddad
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Dani Ejzenberg
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flávio Henrique Galvão
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Wellington Andraus
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luiz Carneiro-D'Albuquerque
- Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
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Kim JS, Kwon JH, Kim KW, Kim J, Kim SY, Jeong WK, Park SH, Yu E, Lee J, Lee SJ, Lee JS, Kim HJ, Song GW, Lee SG. CT Features of Primary Graft Nonfunction after Liver Transplantation. Radiology 2016; 281:465-473. [PMID: 27152552 DOI: 10.1148/radiol.2016152157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose To determine computed tomographic (CT) features of primary graft nonfunction (PNF) after liver transplantation in comparison with those of early graft failure or death by identifiable causes. Materials and Methods Institutional review board approval was obtained and informed consent was waived. Among 3947 adult liver transplantations performed in one institution between May 2002 and May 2015, 72 patients died or had graft failure within 10 days, and 38 of them were evaluated with CT. PNF was diagnosed in 21 patients. The other 17 patients who died or had early graft failure were considered the non-PNF control group. On unenhanced CT images, graft attenuation was compared qualitatively. Graft attenuation was measured quantitatively and, if available, the difference between preoperative and postoperative CT (interval change) attenuation was evaluated. Unenhanced CT was evaluated for relative parenchymal enhancement. Statistical analyses included the Fisher exact and χ2 tests with Yates correction and the Student t test. Results On unenhanced CT images, grafts with PNF more commonly showed low (eight of 26 [31%]) or extremely low (18 of 26 [69%]) qualitative attenuation compared with grafts in the non-PNF group (three of 21 [14%], one of 21 [5%]; P < .001). The mean attenuation value (30.5 HU ± 10.8) was significantly lower and the mean interval change (24.7 HU ± 12.5) was significantly higher in the PNF group than in the non-PNF group (49.7 HU ± 8.0 and 9.7 HU ± 10.1, respectively; P < .001 and P = .001). There was no significant difference in the proportion of grafts that showed poor enhancement on postcontrast CT images between the PNF group and the non-PNF group (nine of 24 [38%] vs two of 20 [10%], respectively; P = .08). Conclusion Recipients with PNF after liver transplantation tended to show low or extremely low attenuation on unenhanced CT images, and this finding was seen more frequently in patients with PNF than in those who died of identifiable causes and in those with early graft failure. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Jin Sil Kim
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
| | - Jae Hyun Kwon
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
| | - Kyoung Won Kim
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
| | - Jihun Kim
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
| | - So Yeon Kim
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
| | - Woo Kyoung Jeong
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
| | - So Hyun Park
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
| | - Eunsil Yu
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
| | - Jeongjin Lee
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
| | - So Jung Lee
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
| | - Jong Seok Lee
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
| | - Hyoung Jung Kim
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
| | - Gi Won Song
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
| | - Sung Gyu Lee
- From the Department of Radiology (J.S.K., K.W.K., S.Y.K., S.H.P., S.J.L., J.S.L., H.J.K.), Division of Liver Transplantation and Hepatobiliary Surgery, and Departments of Surgery (J.H.K., G.W.S., S.G.L.) and Pathology (J.K., E.Y.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea; Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.K.J.); and School of Computer Science and Engineering, Soongsil University, Seoul, Korea (J.L.)
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