Perioperative Management of Patients with Hepatopulmonary Syndrome
AbstractPurpose of ReviewHepatopulmonary syndrome (HPS) is a syndrome of hypoxemia in patients with advanced liver disease, which results in significant mortality in the absence of liver transplantation. Management of HPS is complex both prior to and following liver transplantation as illustrated by a case presentation. This review considers the pathophysiology, diagnosis, assessment of severity, and treatment of HPS with a particular emphasis on perioperative management.Recent FindingsScreening for HPS should be performed in all liver transplant candidates with room air saturation less than 97%. Diagnosis of HPS has been ...
Source: Current Transplantation Reports - September 17, 2018 Category: Transplant Surgery Source Type: research
Infectious Complications in Pancreas Transplantation
AbstractPurpose of ReviewIn addition to the infectious risk associated with all solid organ transplants, pancreas transplantation poses some unique risks associated with surgical technique and host risk factors. This review highlights several key areas of infectious diseases that physicians must consider in patients undergoing pancreas transplantation.Recent FindingsSurgical site infections are common after pancreas transplantation, and empiric antimicrobials, including antifungal coverage, are often needed to reduce the risk of these infections. Cytomegalovirus and Epstein-Barr virus (EBV) infections require close monitor...
Source: Current Transplantation Reports - September 13, 2018 Category: Transplant Surgery Source Type: research
Total Artificial Heart Technology: Where Are We Now?
AbstractPurpose of ReviewThe intended goal of this paper is to review current indications, available devices, and future directions of total artificial heart therapies. Throughout the paper, we sought to help clinicians identify appropriate patients who might be considered for total artificial heart therapy, highlighting the most current data regarding outcomes and adverse events.Recent FindingsThe INTERMACS report on the total artificial heart has recently been published in theJournal of Heart and Lung Transplantation and represents the largest study to date on available TAH therapies. Notable findings include better outc...
Source: Current Transplantation Reports - September 4, 2018 Category: Transplant Surgery Source Type: research
Review of Major Drug-Drug Interactions in Thoracic Transplantation
AbstractPurpose of ReviewThe first human lung transplant surgery in the world was done in 1963, followed by the first heart transplant in 1967, making this year its 50th anniversary. Since then, there has been great advancement in immunotherapy, with the adoption of calcineurin inhibitors (CNI), mycophenolate mofetil, and proliferation signal inhibitors (PSI). However, while these medications are crucial to maintenance of allograft function and prevention of allograft rejection, they have many toxicities and side effects, which make therapeutic dose monitoring and recognition of drug-drug interactions of critical importanc...
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research
Perioperative Assessment and Intraoperative Core Concepts in the Complex Kidney Patient
AbstractPurposeLife span and sense of well-being continue to improve post-transplantation in patients with end-stage kidney disease, despite referral of an older and more medically complex population for transplantation. In this issue of the journal, we review existing evidence about risk assessment in kidney transplant candidates from the perspective of the anesthesiologist. The authors explore cardiovascular assessment and risk in the context of intraoperative events that can influence short- and long-term outcomes.Recent FindingsThe number of patients referred for kidney transplantation continues to increase and has far...
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research
Immunosuppression for Lung Transplantation: Current and Future
AbstractPurpose of the ReviewThe number of lung transplantations performed worldwide continues to increase. There is a growing need in these patients for more effective immunosuppressive medications with less toxicity.Recent FindingsThis review article summarizes the recent studies and developments in lung transplant immunosuppression. Novel immunosuppressive medications and strategies used in other solid organ transplantations are being trialed in lung transplantation. This includes the use of co-stimulation blockers like belatacept and mTOR inhibitors like everolimus. Calcineurin-sparing regimens have been described in a...
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research
Current Hematological Concepts and Viscoelastic-Based Transfusion Practices During Liver Transplantation
ConclusionWhile we were successful in formulating a dosing regimen based on available literature and our own institutional practices for treating deficiencies of clotting factors and fibrinogen, more research is needed to arrive at a dosing regimen for platelets based on functional deficiency. (Source: Current Transplantation Reports)
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research
Impact of Allograft Steatosis on Cardiovascular Outcomes
AbstractPurpose of ReviewCardiovascular events are among the most consequential long-term outcomes in liver transplant recipients. While underlying non-alcoholic fatty liver disease has been independently associated with unfavorable cardiovascular outcomes and increased mortality, it is unclear yet if the same holds true for allograft steatosis. We here review the available data on cardiovascular outcomes after liver transplant with specific focus on allograft steatosis.Recent FindingsTwo subtypes of hepatic allograft steatosis exist, recurrent and de novo, and both are common. Although the current data suggest an associat...
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research
Biopsy-Negative Rejection: a Rare but Difficult Issue in Heart Transplantation
AbstractPurpose of ReviewBiopsy-negative rejection is a condition defined by a cardiac dysfunction with a left ventricular ejection fraction (LVEF) ≤ 45% with normal histology and with the absence of other causes of cardiac allograft damage. The purpose of this review is to determine the incidence of biopsy-negative rejection, the therapeutics, and the outcome in the light of new techniques of evaluation or detection of acute rejection in h eart-transplanted patients. Although rare, many physicians have once experienced this difficult situation. Even though it is considered the gold standard for the diagnosis of reject...
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research
Approaches for Effective Clinical Application of Stem Cell Transplantation
AbstractPurpose of ReviewThis review highlights problems related to translation of advanced therapy medicinal products (ATMPs) from bench to bedsite. Regenerative medicine within the current regulatory frame reveals common hitches in the course of development, translation, and clinical application. This paper suggests outlining a path from the few examples of successfully approved vs unsuccessful advanced therapies.Recent FindingsIn the multitude of ongoing studies, few of them achieved positive results with a final treatment available to patients; this result was possible due to multidisciplinary teams working together fr...
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research
Transplantation for the Very Sick Patient —Donor and Recipient Factors
AbstractPurpose of ReviewPatients with end-stage chronic liver disease (CLD) frequently deteriorate with development of a ‘frail’ state and progress to development of extra-hepatic organ failures. Making the clinical judgement when a patient is ‘too sick’ to proceed with liver transplantation is challenging; we summarise recent studies that may inform decision-making.Recent FindingsReports quantify the impact of both recipient and donor factors related to early post-transplant survival, with consistent adverse association of advanced donor and recipient age, under-nutrition, sarcopenia and impaired functional statu...
Source: Current Transplantation Reports - September 1, 2018 Category: Transplant Surgery Source Type: research
