Advertisement

Transplantation

  • Adam S. Bodzin
  • Ronald W. Busuttil
Chapter

Abstract

The intensive care unit (ICU) is integral in any successful transplant program, as the care of these transplant recipients requires exhaustive multidisciplinary care. After transplantation, these patients have a host of hemodynamic changes that affect both the allograft and global end-organ function. All organ systems remain intricate in the ICU and must be monitored closely as the acuity remains high even after the immediate postoperative period. Managing these patients requires an in-depth understanding of immunosuppressive medications as well as their side effect profiles and drug interactions to safely navigate the care of these patients. Not surprisingly, given these patients have an innate immunosuppressive state in addition to these medications, they remain susceptible to aggressive post-transplant infections. Communication between the ICU and the transplant team remains key to the success of each individual transplanted graft and patient.

Keywords

Transplantation Intensive care Liver Kidney Infection Immunosuppression 

References

  1. 1.
    Bulatao IG, Heckman MG, Rawal B, Aniskevich S, Shine TS, Keaveny AP, et al. Avoiding stay in the intensive care unit after liver transplantation: a score to assign location of care. Am J Transplant. 2014;14(9):2088–96.CrossRefGoogle Scholar
  2. 2.
    Taner CB, Willingham DL, Bulatao IG, Shine TS, Peiris P, Torp KD, et al. Is a mandatory intensive care unit stay needed after liver transplantation? Feasibility of fast-tracking to the surgical ward after liver transplantation. Liver Transpl. 2012;18(3):361–9.CrossRefGoogle Scholar
  3. 3.
    Ponnudurai RN, Koneru B, Akhtar SA, Wachsberg RH, Fisher A, Wilson DJ, et al. Vasopressor administration during liver transplant surgery and its effect on endotracheal reintubation rate in the postoperative period: a prospective, randomized, double-blind, placebo-controlled trial. Clin Ther. 2005;27(2):192–8.CrossRefGoogle Scholar
  4. 4.
    Zhang LP, Li M, Yang L. Effects of different vasopressors on hemodynamics in patients undergoing orthotopic liver transplantation. Chin Med J (Engl). 2005;118(23):1952–8.Google Scholar
  5. 5.
    Biais M, Nouette-Gaulain K, Cottenceau V, Vallet A, Cochard JF, Revel P, et al. Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis. Anesth Analg. 2008;106(5):1480–6. table of contents.CrossRefGoogle Scholar
  6. 6.
    Boldt J. Use of albumin: an update. Br J Anaesth. 2010;104(3):276–84.CrossRefGoogle Scholar
  7. 7.
    Mukhtar A, Aboulfetouh F, Obayah G, Salah M, Emam M, Khater Y, et al. The safety of modern hydroxyethyl starch in living donor liver transplantation: a comparison with human albumin. Anesth Analg. 2009;109(3):924–30.CrossRefGoogle Scholar
  8. 8.
    Gopal PB, Kapoor D, Raya R, Subrahmanyam M, Juneja D, Sukanya B. Critical care issues in adult liver transplantation. Indian J Crit Care Med. 2009;13(3):113–9.CrossRefGoogle Scholar
  9. 9.
    Feltracco P, Barbieri S, Galligioni H, Michieletto E, Carollo C, Ori C. Intensive care management of liver transplanted patients. World J Hepatol. 2011;3(3):61–71.CrossRefGoogle Scholar
  10. 10.
    Glanemann M, Busch T, Neuhaus P, Kaisers U. Fast tracking in liver transplantation. Immediate postoperative tracheal extubation: feasibility and clinical impact. Swiss Med Wkly. 2007;137(13–14):187–91.PubMedGoogle Scholar
  11. 11.
    Biancofiore G, Bindi ML, Romanelli AM, Boldrini A, Bisa M, Esposito M, et al. Fast track in liver transplantation: 5 years’ experience. Eur J Anaesthesiol. 2005;22(8):584–90.CrossRefGoogle Scholar
  12. 12.
    Yost CS, Matthay MA, Gropper MA. Etiology of acute pulmonary edema during liver transplantation: a series of cases with analysis of the edema fluid. Chest. 2001;119(1):219–23.CrossRefGoogle Scholar
  13. 13.
    Saner FH, Pavlakovic G, Gu Y, Fruhauf NR, Paul A, Radtke A, et al. Does PEEP impair the hepatic outflow in patients following liver transplantation? Intensive Care Med. 2006;32(10):1584–90.CrossRefGoogle Scholar
  14. 14.
    Iyer VN, Swanson KL, Krowka MJ. Survival benefits of liver transplant in severe hepatopulmonary syndrome. Am J Respir Crit Care Med. 2013;188(4):514.CrossRefGoogle Scholar
  15. 15.
    Iyer VN, Swanson KL, Cartin-Ceba R, Dierkhising RA, Rosen CB, Heimbach JK, et al. Hepatopulmonary syndrome: favorable outcomes in the MELD exception era. Hepatology. 2013;57(6):2427–35.CrossRefGoogle Scholar
  16. 16.
    O’Grady JG, Wendon J. Pushing the boundaries in hepatopulmonary syndrome. Am J Transplant. 2010;10(2):203–4.CrossRefGoogle Scholar
  17. 17.
    Strasberg SM, Howard TK, Molmenti EP, Hertl M. Selecting the donor liver: risk factors for poor function after orthotopic liver transplantation. Hepatology. 1994;20(4 Pt 1):829–38.CrossRefGoogle Scholar
  18. 18.
    Ploeg RJ, D’Alessandro AM, Knechtle SJ, Stegall MD, Pirsch JD, Hoffmann RM, et al. Risk factors for primary dysfunction after liver transplantation--a multivariate analysis. Transplantation. 1993;55(4):807–13.CrossRefGoogle Scholar
  19. 19.
    Bennett-Guerrero E, Feierman DE, Barclay GR, Parides MK, Sheiner PA, Mythen MG, et al. Preoperative and intraoperative predictors of postoperative morbidity, poor graft function, and early rejection in 190 patients undergoing liver transplantation. Arch Surg. 2001;136(10):1177–83.CrossRefGoogle Scholar
  20. 20.
    Olthoff KM, Kulik L, Samstein B, Kaminski M, Abecassis M, Emond J, et al. Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors. Liver Transpl. 2010;16(8):943–9.CrossRefGoogle Scholar
  21. 21.
    McKenna GJ, Klintmalm GBG. Postoperative Intensive Care Management in Adults. In: Transplantation of the liver. Busuttil RK, Klintmalm GBG (Eds). Saunders; 2015. pp. 866–94.Google Scholar
  22. 22.
    Mourad MM, Liossis C, Gunson BK, Mergental H, Isaac J, Muiesan P, et al. Etiology and management of hepatic artery thrombosis after adult liver transplantation. Liver Transpl. 2014;20(6):713–23.CrossRefGoogle Scholar
  23. 23.
    Kaewlai R, Abujudeh H. Nephrogenic systemic fibrosis. AJR Am J Roentgenol. 2012;199(1):W17–23.CrossRefGoogle Scholar
  24. 24.
    Dohan A, Guerrache Y, Boudiaf M, Gavini JP, Kaci R, Soyer P. Transjugular liver biopsy: indications, technique and results. Diagn Interv Imaging. 2014;95(1):11–5.CrossRefGoogle Scholar
  25. 25.
    Guevara M, Gines P. Hepatorenal syndrome. Dig Dis. 2005;23(1):47–55.CrossRefGoogle Scholar
  26. 26.
    Epstein M. Liver disease. In: Textbook of nephrology. Baltimore: Williams and Willkins; 1995. p. 1105–7.Google Scholar
  27. 27.
    Gonwa TA, Morris CA, Goldstein RM, Husberg BS, Klintmalm GB. Long-term survival and renal function following liver transplantation in patients with and without hepatorenal syndrome – experience in 300 patients. Transplantation. 1991;51(2):428–30.CrossRefGoogle Scholar
  28. 28.
    Smoter P, Nyckowski P, Grat M, Patkowski W, Zieniewicz K, Wronka K, et al. Risk factors of acute renal failure after orthotopic liver transplantation: single-center experience. Transplant Proc. 2014;46(8):2786–9.CrossRefGoogle Scholar
  29. 29.
    Lau C, Martin P, Bunnapradist S. Management of renal dysfunction in patients receiving a liver transplant. Clin Liver Dis. 2011;15(4):807–20.CrossRefGoogle Scholar
  30. 30.
    Faenza S, Santoro A, Mancini E, Pareschi S, Siniscalchi A, Zanzani C, et al. Acute renal failure requiring renal replacement therapy after orthotopic liver transplantation. Transplant Proc. 2006;38(4):1141–2.CrossRefGoogle Scholar
  31. 31.
    Vincent J. ICU management of the liver transplant patient in yearbook of intensive care and emergency medicine. Germany: Springer; 2008. p. 763–76.CrossRefGoogle Scholar
  32. 32.
    Garcia-Martinez R, Rovira A, Alonso J, Jacas C, Simon-Talero M, Chavarria L, et al. Hepatic encephalopathy is associated with posttransplant cognitive function and brain volume. Liver Transpl. 2011;17(1):38–46.CrossRefGoogle Scholar
  33. 33.
    Emiroglu R, Ayvaz I, Moray G, Karakayali H, Haberal M. Tacrolimus-related neurologic and renal complications in liver transplantation: a single-center experience. Transplant Proc. 2006;38(2):619–21.CrossRefGoogle Scholar
  34. 34.
    Sevmis S, Karakayali H, Emiroglu R, Akkoc H, Haberal M. Tacrolimus-related seizure in the early postoperative period after liver transplantation. Transplant Proc. 2007;39(4):1211–3.CrossRefGoogle Scholar
  35. 35.
    Wang WL, Yang ZF, Lo CM, Liu CL, Fan ST. Intracerebral hemorrhage after liver transplantation. Liver Transpl. 2000;6(3):345–8.CrossRefGoogle Scholar
  36. 36.
    Wijdicks EF, de Groen PC, Wiesner RH, Krom RA. Intracerebral hemorrhage in liver transplant recipients. Mayo Clin Proc. 1995;70(5):443–6.CrossRefGoogle Scholar
  37. 37.
    Razonable RR, Findlay JY, O’Riordan A, Burroughs SG, Ghobrial RM, Agarwal B, et al. Critical care issues in patients after liver transplantation. Liver Transpl. 2011;17(5):511–27.CrossRefGoogle Scholar
  38. 38.
    Alangaden GJ, Thyagarajan R, Gruber SA, Morawski K, Garnick J, El-Amm JM, et al. Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant. 2006;20(4):401–9.CrossRefGoogle Scholar
  39. 39.
    Pandey CK, Singh A, Kajal K, Dhankhar M, Tandon M, Pandey VK, et al. Intraoperative blood loss in orthotopic liver transplantation: the predictive factors. World J Gastrointest Surg. 2015;7(6):86–93.CrossRefGoogle Scholar
  40. 40.
    Romero FA, Razonable RR. Infections in liver transplant recipients. World J Hepatol. 2011;3(4):83–92.CrossRefGoogle Scholar
  41. 41.
    Slifkin M, Doron S, Snydman DR. Viral prophylaxis in organ transplant patients. Drugs. 2004;64(24):2763–92.CrossRefGoogle Scholar
  42. 42.
    Lee RA, Gabardi S. Current trends in immunosuppressive therapies for renal transplant recipients. Am J Health Syst Pharm. 2012;69(22):1961–75.CrossRefGoogle Scholar
  43. 43.
    Masuda S, Inui K. An up-date review on individualized dosage adjustment of calcineurin inhibitors in organ transplant patients. Pharmacol Ther. 2006;112(1):184–98.CrossRefGoogle Scholar
  44. 44.
    Danovtich GM. Immunosuppressive protocols for kidney transplantation. In: Handbook of kidney transplantation. Ed: Danovitch GM. Wolters Kluwer 2010. pp. 77–126.Google Scholar
  45. 45.
    Mihatsch MJ, Kyo M, Morozumi K, Yamaguchi Y, Nickeleit V, Ryffel B. The side-effects of ciclosporine-A and tacrolimus. Clin Nephrol. 1998;49(6):356–63.PubMedGoogle Scholar
  46. 46.
    Buchman AL. Side effects of corticosteroid therapy. J Clin Gastroenterol. 2001;33(4):289–94.CrossRefGoogle Scholar
  47. 47.
    Zhou H, Luo Y, Huang S. Updates of mTOR inhibitors. Anticancer Agents Med Chem. 2010;10(7):571–81.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 2.5 International License (http://creativecommons.org/licenses/by-nc/2.5/), which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Authors and Affiliations

  1. 1.Department of Surgery, Section of TransplantationUniversity of ChicagoChicagoUSA
  2. 2.Department of SurgeryUniversity of CaliforniaLos AngelesUSA

Personalised recommendations