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Anaesthesia and intensive care for simultaneous liver-kidney transplantation: A single-centre experience with 12 recipients
BACKGROUND AND AIMS: The perioperative management of patients presenting for simultaneous liver and kidney transplantation (SLKT) is a complex process. We analysed SLKTs performed in our institution to identify preoperative, intraoperative and post-operative challenges encountered in the management....
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Medknow Publications & Media Pvt Ltd
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966351/ https://www.ncbi.nlm.nih.gov/pubmed/27512163 http://dx.doi.org/10.4103/0019-5049.186025 |
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author | Rajakumar, Akila Gupta, Shiwalika Malleeswaran, Selvakumar Varghese, Joy Kaliamoorthy, Ilankumaran Rela, Mohamed |
author_facet | Rajakumar, Akila Gupta, Shiwalika Malleeswaran, Selvakumar Varghese, Joy Kaliamoorthy, Ilankumaran Rela, Mohamed |
author_sort | Rajakumar, Akila |
collection | PubMed |
description | BACKGROUND AND AIMS: The perioperative management of patients presenting for simultaneous liver and kidney transplantation (SLKT) is a complex process. We analysed SLKTs performed in our institution to identify preoperative, intraoperative and post-operative challenges encountered in the management. METHODS: We retrospectively studied the case records of 12 patients who underwent SLKT between 2009 and 2014 and analysed details of pre-operative evaluation and optimisation, intraoperative anaesthetic management and the implications of use of perioperative continuous renal replacement therapy (CRRT) and the post-operative course of these patients. RESULTS: Of the total 12 cases, 4 were under 16 years of age. The indications for SLKT were primary hyperoxaluria (5), congenital hepatic fibrosis with polycystic kidney disease (2), ethanol-related end-stage liver disease (ESLD) with hepatorenal syndrome type 1 (1). Four patients had ESLD with end-stage renal disease due to other causes. Six recipients received live donor grafts and 6 patients received cadaveric grafts. Seven patients received intraoperative CRRT. Mean duration of surgery was 12.5 h. Cardiac output monitors used were trans-oesophageal echocardiogram (2), pulmonary artery catheter (1) and pulse contour cardiac output monitor (3). There was 1 sepsis-related mortality on 7(th) post-operative day. CONCLUSION: A thorough pre-operative evaluation and optimisation, knowledge and anticipation of potential problems, and meticulous intraoperative fluid management guided by appropriate monitoring and use of CRRT when needed can help in achieving successful outcomes. |
format | Online Article Text |
id | pubmed-4966351 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-49663512016-08-10 Anaesthesia and intensive care for simultaneous liver-kidney transplantation: A single-centre experience with 12 recipients Rajakumar, Akila Gupta, Shiwalika Malleeswaran, Selvakumar Varghese, Joy Kaliamoorthy, Ilankumaran Rela, Mohamed Indian J Anaesth Original Article BACKGROUND AND AIMS: The perioperative management of patients presenting for simultaneous liver and kidney transplantation (SLKT) is a complex process. We analysed SLKTs performed in our institution to identify preoperative, intraoperative and post-operative challenges encountered in the management. METHODS: We retrospectively studied the case records of 12 patients who underwent SLKT between 2009 and 2014 and analysed details of pre-operative evaluation and optimisation, intraoperative anaesthetic management and the implications of use of perioperative continuous renal replacement therapy (CRRT) and the post-operative course of these patients. RESULTS: Of the total 12 cases, 4 were under 16 years of age. The indications for SLKT were primary hyperoxaluria (5), congenital hepatic fibrosis with polycystic kidney disease (2), ethanol-related end-stage liver disease (ESLD) with hepatorenal syndrome type 1 (1). Four patients had ESLD with end-stage renal disease due to other causes. Six recipients received live donor grafts and 6 patients received cadaveric grafts. Seven patients received intraoperative CRRT. Mean duration of surgery was 12.5 h. Cardiac output monitors used were trans-oesophageal echocardiogram (2), pulmonary artery catheter (1) and pulse contour cardiac output monitor (3). There was 1 sepsis-related mortality on 7(th) post-operative day. CONCLUSION: A thorough pre-operative evaluation and optimisation, knowledge and anticipation of potential problems, and meticulous intraoperative fluid management guided by appropriate monitoring and use of CRRT when needed can help in achieving successful outcomes. Medknow Publications & Media Pvt Ltd 2016-07 /pmc/articles/PMC4966351/ /pubmed/27512163 http://dx.doi.org/10.4103/0019-5049.186025 Text en Copyright: © Indian Journal of Anaesthesia http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Rajakumar, Akila Gupta, Shiwalika Malleeswaran, Selvakumar Varghese, Joy Kaliamoorthy, Ilankumaran Rela, Mohamed Anaesthesia and intensive care for simultaneous liver-kidney transplantation: A single-centre experience with 12 recipients |
title | Anaesthesia and intensive care for simultaneous liver-kidney transplantation: A single-centre experience with 12 recipients |
title_full | Anaesthesia and intensive care for simultaneous liver-kidney transplantation: A single-centre experience with 12 recipients |
title_fullStr | Anaesthesia and intensive care for simultaneous liver-kidney transplantation: A single-centre experience with 12 recipients |
title_full_unstemmed | Anaesthesia and intensive care for simultaneous liver-kidney transplantation: A single-centre experience with 12 recipients |
title_short | Anaesthesia and intensive care for simultaneous liver-kidney transplantation: A single-centre experience with 12 recipients |
title_sort | anaesthesia and intensive care for simultaneous liver-kidney transplantation: a single-centre experience with 12 recipients |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966351/ https://www.ncbi.nlm.nih.gov/pubmed/27512163 http://dx.doi.org/10.4103/0019-5049.186025 |
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