The evaluation of hemodynamic changes during the reperfusion phase in adult living donor liver transplantations: the role of cardiovascular problems.

OBJECTIVE: This study sought to evaluate the hemodynamic changes of and to analyze the effects of coronary artery disease (CAD) as well as its risk factors on hemodynamic parameters during the reperfusion phase (RP) in adult living donor liver transplantation (ALDLT). PATIENTS AND METHODS: This single-center retrospective study evaluated 154 adult patients being assessed from January 2001 to December 2013 for orthotopic liver transplantation (OLT). The patients were divided into separate groups according to the presence or absence of CAD and its risk factors, including diabetes, hypertension, dyslipidemia, smoking, sex, and age. The hemodynamic parameters were noted during the RP with respect to the patient files. The comparison of the groups and the effects of cardiovascular problems on hemodynamic parameters were statistically analyzed. RESULTS: A decrease of more than 20% in systolic arterial pressure was seen in 16 (16.7%), 7 (43.8%), and 17 (40.5%) patients without CAD, with CAD, and with its high risk factors (>2), respectively (P < .05). Moreover, diastolic hypotension was seen in 59 (38.3%) patients during RP; of those, 10 (62.5%) had CAD and 19 (45.2%) had CAD high-risk factors. The decline in both systolic and diastolic arterial pressure was significantly correlated with the increased number of risk factors (P < .05). CONCLUSIONS: RP in ALDLT remains an issue not only for the surgeons but also for the anesthesiologists. Clinicians should be aware of CAD and its risk factors before OLT and successful management of such problems are mandatory for hemodynamic stability during this formidable process.

Early postoperative pulmonary complications after heart transplantation.

OBJECTIVE: The aim of this study was to determine the types, incidence, and risk factors for early postoperative pulmonary complications in heart transplant recipients. METHODS: We retrospectively collected data from the records of consecutive heart transplantations from January 2003 to December 2013. A total of 83 patients underwent heart transplantation. The data collected for each case were demographic features, duration of mechanical ventilation, respiratory problems that developed during the intensive care unit (ICU) stay, and early postoperative mortality (<30 d). RESULTS: Of the 72 patients considered, 52 (72.2%) were male. The overall mean age at the time of transplantation was 32.1 ± 16.6 years. Twenty-five patients (34.7%) developed early postoperative respiratory complications. The most frequent problem was pleural effusion (n = 19; 26.4%), followed by atelectasis (n = 6; 8.3%), acute respiratory distress syndrome (n = 5; 6.9%), pulmonary edema (n = 4; 5.6%), and pneumonia (n = 3; 4.2%). Postoperative duration of mechanical ventilation (44.2 ± 59.2 h vs 123.8 ± 190.8 h; P = .005) and the length of postoperative ICU stay (10.1 ± 5.8 h vs 19.8 ± 28.9 h; P = .03) were longer among patients who had respiratory problems. Postoperative length of stay in the hospital (22.3 ± 12.5 d vs 30.3 ± 38.3 d; P = .75) was similar in the 2 groups. The overall mortality rate was 12.5% (n = 9). The patients who had respiratory problems did not show higher mortality than those who did not have respiratory problems (16.0% vs 10.6%; P = .71). CONCLUSIONS: Respiratory complications were relatively common in our cohort of heart transplant recipients. However, these complications were mostly self-limiting and did not result in worse mortality.

Rifle criteria for acute kidney dysfunction following liver transplantation: incidence and risk factors.

RIFLE criteria have been used to determine the incidence of acute kidney dysfunction (AKD) after orthotopic liver transplantation (OLT). However, no studies have focused on the incidence of AKD after OLT in patients with normal pre-OLT kidney functions. Using the RIFLE criteria, we determined the incidence and risk factors for AKD after OLT in patients with normal pre-OLT kidney function. We retrospectively analyzed the records of 112 patients who underwent OLT from January 2000 to February 2009 with normal prior kidney function. We investigated three levels of renal dysfunction outlined in the RIFLE criteria: risk (R); injury (I); and failure (F). Preoperative, intraoperative, and postoperative variables were collected. AKD occurred in 64 (57%) OLTs with risk, injury, and failure frequencies of 19%, 11%, and 28%, respectively. Compared with those who did not develop AKD postoperatively, those who did had significantly higher MELD scores (19 ± 7 vs 16 ± 8; P = .018), more frequently use of inotropic agents intraoperatively (54% vs 35%; P = .070), more colloid treatment (300 ± 433 mL vs 105 ± 203 mL; P = .007), longer anhepatic phase (88.0 ± 42.0 minutes vs 73.0 ± 20.0 minutes; P = .037), and a greater incidence of intraoperative acidosis (64% vs 44%; P = .047). Logistic regression analysis revealed that MELD score (odds ratio 1.107, 95% CI 1.022-1.200, P = .013), duration of anhepatic phase (odds ratio 1.020 95% CI 1.000-1.040, P = .053), and intraoperative acidosis (odds ratio 0.277 95% CI 0.093-0.825 P = .021) were independent risk factors for AKD. In conclusion, our results suggested that, based on RIFLE criteria, AKD occurs in more than half of OLTs postoperatively. A higher MELD score, longer anhepatic phase, and occurrence of intraoperative acidosis were associated with AKD.