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Anesthesia and Perioperative Care for Organ Transplantation pp 517–524Cite as

Anesthesia for Multivisceral Transplantation

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Abstract

Advances in surgical techniques, an increased understanding of immunologic reactions, and improvements in immunosuppressive regimens, anesthetic and perioperative critical care, and postoperative surveillance have allowed multivisceral transplantation to emerge as an effective, lifesaving option for patients in whom other therapeutic modalities have failed. The perioperative care of these severely ill patients requires intense multidisciplinary collaboration, particularly within the triangle of surgeons, anesthesiologists, and intensivists. Despite all the progress made, much research remains to be done, especially in the area of patient outcomes, before the procedure can be offered outside a few select, highly specialized tertiary referral centers.

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References

  1. Starzl TE, Todo S, Tzakis A, Alessiani M, Casavilla A, Abu-Elmagd K, Fung JJ. The many faces of multivisceral transplantation. Surg Gynecol Obstet. 1991;172:335–44.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Tzakis AG, Todo S, Starzl TE. Intestinal transplantation. Ann Rev Med. 1994;45:79–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Selvaggi G, Tzakis AG. Intestinal and multivisceral transplantation; future porspectives. Front Biosci. 2007;12:4742–54.

    Article  PubMed  Google Scholar 

  4. Grant D, Abu-Elmagd K, Reyes J, Tzakis A, Lagnas A, Fishbein T, On behalf of Intestine Transplant Registry, et al. 2003 Report of intestine transplant registry. Ann Surg. 2005;241:607–13.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Abu-Elmagd KM, Costa G, Bond GJ, Soltys K, Sindhi R, Wu T, et al. Five hundred intestinal and multivisceral transplantations at a single center. Ann Surg. 2009;250:567–81.

    PubMed  Google Scholar 

  6. Abu-Elmagd KM, Reyes J, Bond G, Mazariegos G, Wu T, Murase N, et al. Clinical inestinal transplantaion; a decade of experience at a single center. Ann Surg. 2001;234:404–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Tzakis AG, Kato D, Levi DM, DeFaria W, Selvaggi G, Weppler D, et al. One hundred multivisceral transplants at a single center. Ann Surg. 2005;242:480–93.

    PubMed  PubMed Central  Google Scholar 

  8. Cai J. Intestine and multivisceral transplantation in the United States: a report of 20-year national registry data 1990-2009. Clin Transpl. 2009;83:101.

    Google Scholar 

  9. Saggi BH, Farmer DG, Yersiz H, Busuttil RW. Surgical advances in liver and bowel transplantation. Anesthesiol Clin N Am. 2004;22: 713–40.

    Article  Google Scholar 

  10. Cruz Jr RJ, Garrido AG, Rocha e Silva M. Early hemodynamic and metabolic changes after total abdominal evisceration for experimental multivisceral transplantation. Acta Cir Bras. 2009;24:156–61.

    Article  PubMed  Google Scholar 

  11. Kanbak M, Karagoz AH, Üzümcügil F. Anesthesia in liver transplantation. In: Abdeldayem H, editor. Liver transplantation—basic issues, InTech 2012. http://www.intechopen.com/books/liver-transplantation-basic-issues/anesthesia-in-liver-transplantation. ISBN: 978-953-51-0016-4.

  12. Mallick IH, Yang W, Winslet MC, Seifalian AM. Ischemia-reperfusion injury of the intestine and protective strategies against injury. Dig Dis Sci. 2004;49:1359–77.

    Article  CAS  PubMed  Google Scholar 

  13. Siniscalchi A, Cucchetti A, Miklosova Z, Lauro A, Zanoni A, Spedicato S, Bernardi E, Aurini L, Pinna AD, Faenza S. Post-reperfusion syndrome during isolated intestinal transplantation: outcome and predictors. Clin Transplant. 2012;26:454–60.

    Article  PubMed  Google Scholar 

  14. Siniscalchi A, Piraccini E, Miklosova Z, Bagni A, D’Errico A, Cucchetti A, Lauro A, Pinna AD, Faenza S. Metabolic, coagulative and hemodynamic changes during intestinal transplant: good predictors of postoperative damage? Transplantation. 2007;84:346–50.

    Article  PubMed  Google Scholar 

  15. Gao L, Ramzan I, Baker B. Neuromuscular paralysis as a pharmacodynamic probe to assess organ function during liver transplantation. J Clin Anesth. 2000;12:615–20.

    Article  CAS  PubMed  Google Scholar 

  16. Verbeeck RK. Pharmacokinetics and dosage adjustment in patients with hepatic dysfunction. Eur J Clin Pharmacol. 2008;64:1147–61.

    Article  CAS  PubMed  Google Scholar 

  17. Verbeeck RK, Musuamba FT. Pharmacokinetics and dosage adjustment in patients with renal dysfunction. Eur J Clin Pharmacol. 2009;65:757–73.

    Article  CAS  PubMed  Google Scholar 

  18. Proulx NL, Akbari A, Garg AX, Rostom A, Jaffey J, Clark HD. Measured creatinine clearance from timed urine collection substantially overestimates glomerular filtration rate in patients with liver cirrhosis: a systematic review and individual patient meta-analysis. Nephrol Dial Transplant. 2005;20:1617–22.

    Article  CAS  PubMed  Google Scholar 

  19. Kostopanagiotou G, Sidiropoulou T, Pyrsopoulos N, Pretto EA, Pandazi A, Matsota P, Arkadopoulos N, Smyrniotis V, Tzakis AG. Anesthestic and perioperative management of intestinal and multivisceral allograft recipient in nontrasplant surgery. Transpl Int. 2008;21:415–27.

    Article  PubMed  Google Scholar 

  20. http://www.anthem.com/medicalpolicies/policies/mp_pw_a053824.htm.

  21. Steinman TI, Becker BN, Frost AE, Olthoff KM, Smart FW, Suki WN, Wilkinson AH, Clinical Practice Committee, American Society of Transplantation. Guidelines for the referral and management of patients eligible for solid organ transplantation. Transplantation. 2001;71:1189.

    Article  CAS  PubMed  Google Scholar 

  22. Howard L, Malone M. Current status of home parenteral nutrition in the United States. Transplant Proc. 1996;28:2691–5.

    CAS  PubMed  Google Scholar 

  23. Mangus RS, Tector AJ, Kubal CA, Fridell JA, Vianna RM. Multivisceral transplantation: expanding indications and improving outcomes. J Gastrointest Surg. 2013;17:179–87.

    Article  PubMed  Google Scholar 

  24. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA). Eur Heart J. 2009;30:2769–812.

    Google Scholar 

  25. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009;120:e169–276.

    Google Scholar 

  26. Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, Weiss K, Owens DK, Aronson M, Barry P, Casey Jr DE, Cross Jr JT, Fitterman N, Sherif KD, Weiss KB, Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006;144:575–80.

    Article  PubMed  Google Scholar 

  27. Selvaggi G, Gyamfi A, Kato T, Gelman B, Aggarwal S, Begliomini B, Bennett J, Nishida S, Tzakis AG. Analysis of vascular access in intestinal transplant recipients using the Miami classification from the VIIIth international small bowel transplant symposium. Transplantation. 2005;79:1639–43.

    Article  PubMed  Google Scholar 

  28. Matsusaki T, Sakai T, Boucek CD, Abu-Elmagd K, Martin LM, Amesur N, Thaete LF, Hilmi IA, Planinsic RM, Aggarwal S. Central venous thrombosis and perioperative vascular access in adult intestinal transplantation. Br J Anaesth. 2012;108:776–83.

    Article  CAS  PubMed  Google Scholar 

  29. Jacque JJ. Anesthetic considerations for multivisceral transplantation. Anesthesiol Clin N Am. 2004;22:741–51.

    Article  Google Scholar 

  30. Lomax S, Klucniks A, Griffiths J. Anaesthesia for intestinal transplantation. Contin Educ Anaesth Crit Care Pain. 2011;11:1–4.

    Article  Google Scholar 

  31. Planinsic RM. Anesthetic management for small bowel transplantation. Anesthesiol Clin N Am. 2004;22:675–85.

    Article  Google Scholar 

  32. Fernandez JF, Levine SM, Restrepo MI. Technologic advances in endotracheal tubes for prevention of ventilator-associated pneumonia. Chest. 2012;142:231–8.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, Marret E, Beaussier M, Gutton C, Lefrant JY, Allaouchiche B, Verzilli D, Leone M, De Jong A, Bazin JE, Pereira B, Jaber S, IMPROVE Study Group. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013;369:428–37.

    Article  CAS  PubMed  Google Scholar 

  34. Della Roca G, Brondani A, Costa MG. Intraoperative hemodynamic monitoring during organ transplantation; what is new? Curr Opin Organ Transplant. 2009;14:291–6.

    Article  Google Scholar 

  35. Gu J, Tao G, Yi B, Liu D, Guo Y, Wang H, Lu K. Hemodynamic monitoring in pigs undergoing orthotopic abdominal multivisceral transplantation. Transplant Proc. 2009;41:4376–81.

    Article  CAS  PubMed  Google Scholar 

  36. Siniscalchi A, Spedicato S, Dante A, Riganello I, Bernardi E, Pierucci E, et al. Fluid management of patients undergoing intestinal and multivisceral transplantation. Transplant Proc. 2008;40: 2031–2.

    Article  CAS  PubMed  Google Scholar 

  37. Pugsley J, Lerner AB. Cardiac output monitoring: is there a gold standard and how do the newer technologies compare? Semin Cardiothorac Vasc Anesth. 2010;14:274–82.

    Article  PubMed  Google Scholar 

  38. Tsai YF, Su BC, Lin CC, Liu FC, Lee WC, Yu HP. Cardiac output derived from arterial pressure waveform analysis: validation of the third-generation software in patients undergoing orthotopic liver transplantation. Transplant Proc. 2012;44:433–7.

    Article  PubMed  Google Scholar 

  39. Biais M, Nouette-Gaulain K, Cottenceau V, Vallet A, Cochard JF, Revel P, Sztark F. Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis. Anesth Analg. 2008; 106:1480–6.

    Article  PubMed  Google Scholar 

  40. Hadian M, Kim HK, Severyn DA, Michael R, Pinsky MR. Cross-comparison of cardiac output trending accuracy of LiDCO, PiCCO, FloTrac and pulmonary artery catheters. Crit Care. 2010;14:R212.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Marik PE, Baram M. Noninvasive hemodynamic monitoring in the intensive care unit. Crit Care Clin. 2007;23:383–400.

    Article  CAS  PubMed  Google Scholar 

  42. Uchino S, Bellomo R, Morimatsu H, Sugihara M, French C, Stephens D, Wendon J, Honore P, Mulder J, Turner A, PAC/PiCCO Use and Likelihood of Success Evaluation [PULSE] Study Group. Pulmonary artery catheter versus pulse contour analysis: a prospective epidemiological study. Crit Care. 2006;10:R174.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Kuper M, Gold SJ, Callow C, Quraishi T, King S, Mulreany A, Bianchi M, Conway DH. Intraoperative fluid management guided by oesophageal Doppler monitoring. BMJ. 2011;342:d3016.

    Article  PubMed  Google Scholar 

  44. Phypers B, Pierce JMT. Lactate physiology in health and disease. Continuing education in anaesthesia. Crit Care Pain. 2006;6:128–32.

    Google Scholar 

  45. Plachky J, Hofer S, Volkmann M, Martin E, Bardenheuer HJ, Weigand MA. Regional cerebral oxygen saturation monitoring during liver transplantation. Anesth Analg. 2004;99:344–9.

    Article  CAS  PubMed  Google Scholar 

  46. Smith CE, Wagner K. Principles of fluid and blood warming in trauma. Int TraumaCare (ITACCS). 2008;18:71–9.

    Google Scholar 

  47. Comunale ME. A laboratory evaluation of the level 1 rapid infuser (H1025) and the Belmont instrument fluid management system (FMS 2000) for rapid transfusion. Anesth Analg. 2003;97:1064–9.

    Article  PubMed  Google Scholar 

  48. Russell SH, Freeman JW. Comparison of bladder, oesophageal and pulmonary artery temperature in major abdominal surgery. Anaesthesia. 1996;51:338–40.

    Article  CAS  PubMed  Google Scholar 

  49. Kozek-Langenecker SA. Perioperative coagulation monitoring. Best Pract Res Clin Anaesthesiol. 2010;24:27–40.

    Article  PubMed  Google Scholar 

  50. Goerlinger K. Coagulation management during liver transplantation. Hamostaseologie. 2006;26 Suppl 1:S64–75.

    Google Scholar 

  51. Siniscalchi A, Spedicato S, Lauro A, Pinna AD, Cucchetti A, Dazzi A, Piraccini E, Begliomini B, Braglia V, Serri T, Faenza S. Intraoperative coagulation evaluation of ischemia-reperfusion injury in small bowel transplantation: a way to explore. Transplant Proc. 2006;38:820–2.

    Article  CAS  PubMed  Google Scholar 

  52. Siniscalchi A, Piraccini E, Cucchetti A, Lauro A, Maritozzi G, Miklosova Z, Ravaioli M, Pinna AD, Faenza S. Analysis of cardiovascular, acid-base status, electrolyte, and coagulation changes during small bowel transplantation. Transplant Proc. 2006;38: 1148–50.

    Article  CAS  PubMed  Google Scholar 

  53. Sankarankutty A, Nascimento B. Teodoro da Luz L, Rizoli S. TEG® and ROTEM® in trauma: similar test but different results? World J Emerg Surg. 2012;7 Suppl 1:S3.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Coakley M, Reddy K, Mackie I, Mallett S. Transfusion triggers in orthotopic liver transplantation: a comparison of the thromboelastometry analyzer, the thromboelastogram, and conventional coagulation tests. J Cardiothorac Vasc Anesth. 2006;20:548–53.

    Article  PubMed  Google Scholar 

  55. Segall N, Bonifacio AS, Schroeder RA, Barbeito A, Rogers D, Thornlow DK, Emery J, Kellum S, Wright MC, Mark JB, Durham VA Patient Safety Center of Inquiry. Can we make postoperative patient handovers safer? A systematic review of the literature. Anesth Analg. 2012;115:102–15.

    Article  PubMed  Google Scholar 

  56. Petrovic MA, Aboumatar H, Baumgartner WA, Ulatowski JA, Moyer J, Chang TY, Camp MS, Kowalski J, Senger CM, Martinez EA. Pilot implementation of a perioperative protocol to guide operating room-to-intensive care unit patient handoffs. J Cardiothorac Vasc Anesth. 2012;26:11–6.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, 33136, FL, USA

    Edward Gologorsky M.D.

  2. Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    Kyota Fukazawa M.D.

Authors
  1. Edward Gologorsky M.D.
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  2. Kyota Fukazawa M.D.
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Correspondence to Kyota Fukazawa M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

    Kathirvel Subramaniam

  2. Department of Anesthesiology The Clinical and Translational Science Institute The McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Tetsuro Sakai

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Gologorsky, E., Fukazawa, K. (2017). Anesthesia for Multivisceral Transplantation. In: Subramaniam, K., Sakai, T. (eds) Anesthesia and Perioperative Care for Organ Transplantation. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6377-5_41

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  • DOI: https://doi.org/10.1007/978-1-4939-6377-5_41

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