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Perioperative Management for Patients with a Solid Organ Transplant

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Practical Trends in Anesthesia and Intensive Care 2018

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Abstract

The need for surgery in the early or late posttransplant period is increasing in the solid organ transplanted population: between 15% and 40% of the solid organ transplant recipients will undergo invasive procedures:—as a consequence, these patients have to be assessed for every form of anesthesia (general, locoregional) or sedation (from moderate to deep sedation) to undergo elective and emergency non-transplant surgery, for interventional radiologic and endoscopic procedures (gastrointestinal, thoracic, or urologic) and for traumatic events. Aging of the recipients, the increasing number of comorbidities (particularly cardiopulmonary, metabolic, and gastrointestinal), and the occurrence of de novo cancer are creating a new, relevant form of chronic illness population every anesthesiologist can find in everyday clinical practice. We will review the anesthesiological and perioperative management of heart-, lung-, kidney-, and liver-transplanted patients, focusing on the peculiar aspects of the new posttransplant physiology introduced by the denervated graft, able to impact on the conduction of the surgical anesthesia and on the immediate postoperative period. Preoperative assessment and organ-specific anesthesiological issues will be reviewed.

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References

  1. Avoina L, Pretto E. Anesthesia for non-transplant surgery in the organ transplant recipient. In: Pretto Jr EA, Biancofiore G, et al., editors. Oxford textbook of transplant anaesthesia and critical care. Oxford: Oxford University press; 2015. https://doi.org/10.1093/med/9780199651429.001.0001.

    Chapter  Google Scholar 

  2. Toivonen HJ. Anaesthesia for patients with a transplanted organ. Acta Anaeshesiol Scand. 2000;44:812–33.

    Article  CAS  Google Scholar 

  3. Kastopanagiotou G, et al. Anesthetic and perioperative management of adult transplant recipients in non transplant surgery. Anesth Analg. 1999;89:613–22.

    Google Scholar 

  4. Baisden JS. Anesthesia for non cardiac surgery following thoracic organ transplantation, Chapter 18. In: Subramaniam K, Sakai T, editors. Anesthesia and perioperative care for organ transplantation. New York, NY: Springer; 2016. p. 249–59. https://doi.org/10.1007/978-1-4939-6377-5_18.

    Chapter  Google Scholar 

  5. Hoetzel A. General anesthesia for the patient with ESLD and post liver transplantation, Chapter 31. In: Subramaniam K, Sakai T, editors. Anesthesia and perioperative care for organ transplantation. New York, NY: Springer; 2016. p. 395–407. https://doi.org/10.1007/978-1-4939-6377-5_31.

    Chapter  Google Scholar 

  6. Hardinger KL, Agha IA, Brennan DC. Immunosuppressive agents, Chapter 3. In: Ljungman P, Snydman D, Boeckh M, editors. Transplant infections. 4th ed. Cham: Springer International Publishing; 2016. p. 31–46. https://doi.org/10.1007/978-3-319-28797-3_3.

    Chapter  Google Scholar 

  7. De Gasperi A, Feltracco P, Mazza E, Ceravola E. Pulmonary complications in patients receiving a solid-organ transplant. Curr Opin Crit Care. 2014;20:411–9. https://doi.org/10.1097/MCC.0000000000000120.

    Article  PubMed  Google Scholar 

  8. Almaghrabi R, Clancy CJ, Nguyen NH. Prevention of perioperative infections in organ transplant recipients, Chapter 2. In: Subramaniam K, Sakai T, editors. Anesthesia and perioperative care for organ transplantation. New York, NY: Springer; 2016. https://doi.org/10.1007/978-1-4939-6377-5_18.

    Chapter  Google Scholar 

  9. Bromberg JS, Baliga P. Stress steroids are not required for patients receiving a renal allograft and undergoing operation. J Am Coll Surg. 1995;180:532–6.

    CAS  PubMed  Google Scholar 

  10. Girella VN, Pantuc CB, et al. Effects of cyclosporine on anesthetic action. Anesth Analg. 1987;66:703–6.

    Article  Google Scholar 

  11. Turillazzi E, D’Errico S, Neri M, Riezzo I, Fineschi V. A fatal case of fulminant hepatic necrosis following sevoflurane anesthesia. Toxicol Pathol. 2007;35:840–5.

    Article  Google Scholar 

  12. Siai A, Kaplan RF, Davis RF. Prolonged neuromuscolar blockade and ventilatory failure after renal transplantation and cyclosporine. Can J Anesth. 1990;37:543–8.

    Article  Google Scholar 

  13. Mazze RI, et al. The effects of sevoflurane on serum creatinine and blood urea nitrogen concentrations: a retrospective, twenty-two center, comparative evaluation of renal function in adult surgical patients. Anesth Analg. 2000;90:683–8.

    Article  CAS  Google Scholar 

  14. Crosby E, Robblee JA. Cyclosporine-pancuronium interaction in a patient with a renal allograft. Can J Anesth. 1988;35:300–2.

    Article  CAS  Google Scholar 

  15. Gramstad L, et al. Interaction of cyclosporine and its solvent cremophor with atracurium and vecuronium: studies in the cat. Br Anaesth. 1986;58:1149–55.

    Article  CAS  Google Scholar 

  16. Dhar R. Neurologic complications of transplantation. Neurocrit Care. 2018;28:4–11.

    Article  CAS  Google Scholar 

  17. Song T, Rao Z, Tan Q, Qiu Y, Liu J, Huang Z, Wang X, Lin T. Calcineurin inhibitors associated posterior reversible encephalopathy syndrome in solid organ transplantation: report of 2 cases and literature review. Medicine. 2016;95:e3173.

    Article  Google Scholar 

  18. Fishman JA. Infection in solid-organ transplant recipients. New Engl J Med. 2007;357:2601–14.

    Article  CAS  Google Scholar 

  19. Raval Z, Harinstein ME, Skaro AI, Erdogan A, DeWolf AM, Shah SJ, Fix OK, Kay N, Abecassis MI, Gheorghiade M, Flaherty JD. Cardiovascular risk assessment of the liver transplant candidate. J Am Coll Cardiol. 2011;58:223–31.

    Article  Google Scholar 

  20. Kristensen K, et al. ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Eur J Anaesthesiol. 2014;31:1–57.

    Google Scholar 

  21. Fleisher L, et al. ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Executive summary. Circulation. 2014;130:2215.

    Article  Google Scholar 

  22. European Association for the Study of the Liver. EASL clinical practice guidelines: liver transplantation. J Hepatol. 2016;64:433.

    Article  Google Scholar 

  23. Murphy DA, et al. The heart reinnervates after transplantation. Ann Thorac Surg. 2000;69:1769–81.

    Article  CAS  Google Scholar 

  24. Cristalli A, De Gasperi A, Prosperi M, Mazza E, Puttini M, Palmieri B. Abdominal aortic aneurysm resection following cholecystectomy and heart transplantation. Case report. Minerva Anestesiol. 2001;67:149–55.

    CAS  PubMed  Google Scholar 

  25. Hammer GB, et al. Post transplant lymphoproliferative disease may present with severe airway obstruction. Anesthesiology. 1998;89:263–5.

    Article  CAS  Google Scholar 

  26. Del Rio JM, Daneshmand MA, Hartwig GH. Postoperative critical care of lung transplant patients, Chapter 10. In: Subramaniam K, Sakai T, editors. Anesthesia and perioperative care for organ transplantation. New York, NY: Springer; 2016. p. 111–24. https://doi.org/10.1007/978-1-4939-6377-5_10.

    Chapter  Google Scholar 

  27. Consensus conference on perioperative renal protection. Ann Franc Anesth. 2005;24:87–119.

    Google Scholar 

  28. Lee TH, et al. Differential protective effects of volatile anesthetic against renal ischemia reperfusion injury in vivo. Anesthesiology. 2004;101:1313–23.

    Article  CAS  Google Scholar 

  29. Ladha KS, Bateman BT, Houle TT, MAC DJ, Vidal Melo MF, Huybrechts KF, Kurth T, Eikermann M. Variability in the use of protective mechanical ventilation during general anesthesia. Anesth Analg. 2018;126:503–12.

    Article  Google Scholar 

  30. Biancofiore G, Cecconi M, Della Rocca G. A web-based Italian survey of current trends, habits and beliefs in hemodynamic monitoring and management. J Clin Monit Comput. 2015;29:635–4.

    Article  Google Scholar 

  31. Mc Ilroy D, Sladen RN. Renal physiology, pathophysiology and pharmacology, Chapter 23. In: Miller’s anesthesia. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014. p. 545–90.

    Google Scholar 

  32. Steadman R, Wray C. Anesthesia for abdominal organ transplantation, Chapter 74. In: Miller’s anesthesia. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014. p. 2262–91.

    Google Scholar 

  33. Perouanski M, Pearce R, Hammings H. Inhaled anaesthetics: mechanisms of action, Chapter 25. In: Miller’s anesthesia. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014. p. 614–37.

    Google Scholar 

  34. Forman S, Ishizawa Y. Inhaled anaesthetics: pharmacokinetics, Chapter 26. In: Miller’s anesthesia. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014. p. 638–69.

    Google Scholar 

  35. Vuyk J, Sitsen E, Reekers M. Intravenous anesthetics, Chapter 30. In: Miller’s anesthesia. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014. p. 821–63.

    Google Scholar 

  36. Cingi E, Beebe DS, Harmon JV, Belani K. Preoperative recipient evaluation and preparation (kidney), Chapter 20. In: Subramaniam K, Sakai T, editors. Anesthesia and perioperative care for organ transplantation. New York, NY: Springer; 2016. p. 275–9. https://doi.org/10.1007/978-1-4939-6377-5_20.

    Chapter  Google Scholar 

  37. De Pietri L, DeGasperi A, Feltracco P, Biancofiore G, Sensolo M, Sacerdoti D. Management of severe bleeding in liver disease and transplantation, Chapter 10. In: Ranucci M, Simioni P, editors. Point-of-care tests for severe hemorrhage: a manual for diagnosis and treatment. New York, NY: Springer; 2016. ISBN: 978-3-319-24793-9 (Print) 978-3-319-24795-3.

    Google Scholar 

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Authors and Affiliations

  1. 2° Servizio Anestesia e Rianimazione - ASST GOM Ospedale Niguarda, Piazza Ospedale Maggiore 3, Milan, Italy

    Laura Petrò, Alessandra Ponti, Elena Roselli, Manlio Prosperi & Andrea De Gasperi

Authors
  1. Laura Petrò
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  2. Alessandra Ponti
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  3. Elena Roselli
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  4. Manlio Prosperi
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  5. Andrea De Gasperi
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Correspondence to Andrea De Gasperi .

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Editors and Affiliations

  1. Intensive Therapy, University of Milan, San Paolo Hospital, Milan, Italy

    Davide Chiumello

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Petrò, L., Ponti, A., Roselli, E., Prosperi, M., De Gasperi, A. (2019). Perioperative Management for Patients with a Solid Organ Transplant. In: Chiumello, D. (eds) Practical Trends in Anesthesia and Intensive Care 2018. Springer, Cham. https://doi.org/10.1007/978-3-319-94189-9_6

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  • DOI: https://doi.org/10.1007/978-3-319-94189-9_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-94188-2

  • Online ISBN: 978-3-319-94189-9

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