Short-term Results of Liver Transplantation With Octogenarian Donors.

BACKGROUND: There are increasingly more patients awaiting liver transplantation while the number of donors has remained stable. It has been proven that grafts from donors older than 60 years have comparable results with those from younger donors. It is unclear whether this is so with donors older than 80 years old. MATERIAL AND METHODS: This was a retrospective study of all adult liver transplantations at our institution between March 2011 and December 2015. We compared 1-, 3-, 6-, and 12-month graft survival rates from donors <80 years and ≥80 years. We also compared postoperative complications: infections, acute kidney injury, need for readmission in the intensive care unit, length of stay, mechanical ventilation, and specific graft complications. We considered differences in each age group regarding the presence of hepatitis C virus (HCV). RESULTS: Of 177 recipients, 38 received grafts from octogenarian donors (21.5%). Survival rates were very similar in the groups (97%, 93%, 91%, and 87% for donors <80 years and 95%, 92%, 87%, and 76% for donors ≥80 years). Although for younger grafts, 1-year survival rates were slightly lower for HCV+ patients (80% vs 89%; log-rank 0.205), this difference does not exist for elderly donors. The incidence of postoperative complications was similar in both groups. CONCLUSIONS: Livers from octogenarian donors are acceptable for liver transplantation provided that thorough assessment and selection is made by avoiding other known poor prognosis factors. The presence of HCV did not affect survival rates.

Effects of the Hypnotic Agent on Primary Graft Dysfunction After Liver Transplantation.

BACKGROUND: Morbidity and mortality rates in orthotopic liver transplantation have decreased in the past few years. Risk factors related to severe postoperative complications, such as primary graft dysfunction, still need to be analyzed. We evaluated the influence of the hypnotic agent used during anesthesia on primary graft dysfunction. METHODS: We performed a retrospective analysis of 419 consecutive patients who received a liver transplant between 2005 and 2013 in a single center. We analyzed the incidence of primary graft dysfunction (defined as alanine aminotransferase or aspartate aminotransferase levels higher than 1500 IU/L on the first 3 days after surgery) and if the hypnotic agent was associated with this event. RESULTS: The incidence of primary graft dysfunction was 42.2% (114 patients), similar in both groups (propofol group, 89 patients, 43.2% and sevoflurane group, 25 patients, 39.1%). In the multivariate analysis, we did not find any relationship between the hypnotic agent (propofol or sevoflurane) and early graft dysfunction. CONCLUSIONS: In our patients, we found no differences in the incidence of liver graft dysfunction according to the hypnotic used during transplantation. We can suggest that both drugs (sevoflurane and propofol) are equally safe in orthotopic liver transplantation.

[Retrospective comparative study between sevoflurane and propofol in maintaining anaesthesia during liver transplant: Effects on kidney and liver function]. / Estudio retrospectivo comparativo entre sevoflurano y propofol en el mantenimiento de la anestesia durante el trasplante hepático. Efectos sobre la función renal y hepática.

OBJECTIVE: To compare the post-operative effects of sevoflurane versus propofol on liver and kidney function while maintaining anaesthesia in the orthotopic liver transplant (OLT), as well as to analyse the short-term survival as regards these functions. PATIENTS AND METHODS: A retrospective analysis was conducted on patients subjected to an OLT between January 2002 and December 2009. Patients on pre-transplant haemodialysis, re-transplants, and hepatorenal transplants were excluded. The incidence of acute renal failure, initial dysfunction of the graft, reperfusion syndrome, rejection, and the transaminase peak depending value depending on the hypnotic used, were recorded. RESULTS: About one-third (31.2%) of the patients developed acute renal failure and 11.9% an initial dysfunction, with no differences between the groups. There was a tendency for a lower incidence of initial dysfunction of the graft in the sevoflurane group (8.6% compared to 12.8%), a lower transaminase peak (greater than 2000 U/L, 12.1% versus 15.9%), and a lower incidence of reperfusion syndrome (10.3% compared to 21.6%). CONCLUSIONS: Despite the fact that the renal metabolism sevoflurane is elevated, we did not find any higher incidence of acute renal failure. Sevoflurane in the liver transplant anaesthesia is as least equally as safe propofol as regards renal function and liver function. New prospective studies are needed to clarify the possible effects of the hypnotic in liver transplant.

Estudio retrospectivo comparativo entre sevoflurano y propofol en el mantenimiento de la anestesia durante el trasplante hepático. Efectos sobre la función renal y hepática / Retrospective comparative study between sevoflurane and propofol in maintaining anaesthesia during liver transplant: effects on kidney and liver function

Objetivo. Comparar la repercusión postoperatoria sobre la función hepática y renal del sevofluorano frente al propofol durante el mantenimiento de la anestesia en el trasplante hepático ortotópico, así como analizar la supervivencia a corto plazo en relación a dichas funciones. Pacientes y métodos. Análisis retrospectivo de pacientes sometidos a THO entre enero de 2002 y diciembre de 2009. Fueron excluidos los pacientes con hemodiálisis pretrasplante, los retrasplantes y trasplantes hepatorrenales. Se comparó la incidencia de insuficiencia renal aguda, disfunción inicial del injerto, síndrome de reperfusión, rechazo y el pico máximo de transaminasas en función del hipnótico utilizado. Resultados. Un 31,2% de los pacientes desarrolló insuficiencia renal aguda y un 11,9% disfunción inicial, sin diferencias entre los grupos. Hubo tendencia a una menor incidencia de disfunción inicial del injerto en el grupo sevoflurano (8,6 frente a 12,8%), menor pico de transaminasas (más de 2.000 U/L, 12,1 frente a 15,9%) y menor incidencia de síndrome de reperfusión (10,3 frente a 21,6%). Conclusiones. A pesar de que en el trasplante el metabolismo renal del sevofluorano está aumentado, no hemos encontrado mayor incidencia de insuficiencia renal aguda. El sevofluorano en la anestesia del trasplante de hígado es al menos igual de seguro sobre la función renal y la función hepática que el propofol. Son necesarios nuevos trabajos prospectivos para clarificar la posible repercusión del hipnótico en el trasplante de hígado(AU)

Objective. To compare the post-operative effects of sevoflurane versus propofol on liver and kidney function while maintaining anaesthesia in the orthotopic liver transplant (OLT), as well as to analyse the short-term survival as regards these functions. Patients and methods. A retrospective analysis was conducted on patients subjected to an OLT between January 2002 and December 2009. Patients on pre-transplant haemodialysis, re-transplants, and hepatorenal transplants were excluded. The incidence of acute renal failure, initial dysfunction of the graft, reperfusion syndrome, rejection, and the transaminase peak depending value depending on the hypnotic used, were recorded. Results. About one-third (31.2%) of the patients developed acute renal failure and 11.9% an initial dysfunction, with no differences between the groups. There was a tendency for a lower incidence of initial dysfunction of the graft in the sevoflurane group (8.6% compared to 12.8%), a lower transaminase peak (greater than 2000 U/L, 12.1% versus 15.9%), and a lower incidence of reperfusion syndrome (10.3% compared to 21.6%). Conclusions. Despite the fact that the renal metabolism sevoflurane is elevated, we did not find any higher incidence of acute renal failure. Sevoflurane in the liver transplant anaesthesia is as least equally as safe propofol as regards renal function and liver function. New prospective studies are needed to clarify the possible effects of the hypnotic in liver transplant(AU)

[Intestinal transplantation in adults: present situation and future prospects]. / Trasplante intestinal del adulto. Situación actual y perspectivas de futuro.

Intestinal transplantation is becoming more firmly established as a treatment for intestinal failure in patients whose home parenteral nutrition regimens have caused serious side effects. Outcomes have improved spectacularly over recent years thanks to the refinement of surgical techniques and the introduction of new immunosuppressants, and also to greater experience in anesthetic and postoperative management of intestinal transplant patients. The main causes of high morbidity and mortality continue to be sepsis and acute rejection of the graft. Both graft and patient survival have improved with the advent of the immunosuppressant regimens based on Tacrolimus, although survival rates are still far below those reported for other solid organ transplants. The first intestinal transplant performed in Spain took place in July 2002 in our hospital and the results were promising. Given this new challenge for anesthesiologists, we decided to review current trends in the perioperative management of patients receiving isolated intestinal transplants, the main complications that arise, treatment strategies, and future prospects.