Cardiac risk evaluation for abdominal transplantation:

Meeting report of the 19th Annual International Congress of the International Liver Transplantation Society (Sydney Convention and Exhibition Centre, Sydney, Australia, June 12-15, 2013)

The International Liver Transplantation Society held its annual meeting from June 12 to 15 in Sydney, Australia. More than 800 registrants attended the congress, which opened with a conference celebrating 50 years of liver transplantation (LT). The program included series of featured symposia, focused topic sessions, and oral and poster presentations. This report is by no means all-inclusive and focuses on specific abstracts on key topics in LT. Similarly to previous reports, this one presents data in the context of the published literature and highlights the current direction of LT.

Postoperative care/critical care of the transplant patient

Critical care of the general surgical patient requires synthesis of the patient's physiology, intraoperative events, and preexisting comorbidities. Evaluating an abdominal solid-organ transplant recipient after surgery adds a new dimension to clinical decisions because the transplanted allograft has undergone its own physiologic challenges and now must adapt to a new environment. This donor-recipient interaction forms the foundation for assessment of early allograft function (EAF). The intensivist must accurately assess and support EAF within the context of the recipient's current physiology and preexisting comorbidities. Optimizing EAF is essential because allograft failure is a significant predictor of recipient morbidity and mortality.

Cardiovascular and renal complications in patients receiving a solid-organ transplant

PURPOSE OF REVIEW

Cardiovascular and renal complications among solid-organ transplant recipients are a frequent source of morbidity. Appropriate management of these complications throughout the perioperative period significantly affects long-term recipient survival. This review details the identification, management, and potential preventive strategies for perioperative cardiovascular and renal complications among solid-organ transplant recipients.

RECENT FINDINGS

Abdominal transplant candidates have a significantly higher prevalence of risk factors for obstructive coronary artery disease than the general population. There is no consensus on pretransplant screening for coronary artery disease or determination of perioperative risk in candidates awaiting transplantation. Limitations of noninvasive cardiac screening tests such as dobutamine stress echocardiography and myocardial perfusion scintigraphy complicate preoperative evaluation and cardiac risk stratification. Coronary angiography remains the definitive mechanism for determining the presence and severity of coronary artery disease prior to transplantation; however, the relationship between angiographically documented coronary artery disease and cardiovascular morbidity after transplantation is inconsistent. This has raised speculation that perioperative adverse cardiac events are not principally caused by obstructive coronary artery disease but other acute events related to surgical intervention and allograft function. Current data indicate coronary angiography is safe even with patients demonstrating renal insufficiency. A cardiac screening program should reflect the patient population, dynamics of the transplant program, and institutional expertise. The development of classification schemes for defining and categorizing acute kidney injury reflects the importance of preserved renal function in long-term recipient survival. The potential of serum markers as indicators of acute kidney injury has provided a foundation for understanding the global influence of surgical intervention and allograft function upon recipient survival.

SUMMARY

Meticulous attention to all aspects of the transplant process, including operative events and early allograft function, is necessary to minimize morbidity. Further research is necessary to identify mechanisms that support and improve early allograft function to optimize recipient long-term survival.