Transplantation proceedings
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Kidney transplantation from donors after cardiac death (Type III Maastricht category) is a therapeutic option for patients with terminal renal failure. ⋯ Kidney transplantation with grafts from donors after cardiac arrest Maastricht Type III evolves favorably in the short term. According to preliminary results, controlled asystole donation could be an effective alternative to transplantation.
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Stroke volume variation (SVV) is known to be a simple and less invasive hemodynamic parameter for evaluating fluid responsiveness and preload status. Central venous pressure (CVP) has been targeted to achieve an adequate level for improving the graft perfusion and long-term graft function in kidney transplantation (KT) recipients, despite the various potential complications. The aim of this study was to investigate whether SVV could substitute for CVP in guiding intravascular volume management during KT. ⋯ SVV may replace CVP in the volume management of patients who have undergone KT. Our results suggest that SVV can guide volume management to improve graft perfusion at critical time points during KT.
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Patients with end-stage liver disease and severe aortic stenosis pose a significant perioperative management challenge during liver transplantation (OLT). This patient population is at risk for significant morbidity and mortality and is often denied transplantation. ⋯ Valvuloplasty should be considered as an option to reduce perioperative risk in this patient population.
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Preservation of donor hearts for transplantation has traditionally been performed with the use of static cold storage. We have developed and tested a novel gravity-powered system of cold crystalloid perfusion for prolonged donor heart preservation. ⋯ Continuous hypothermic crystalloid perfusion provides myocardial preservation superior to cold storage for long-term heart preservation, with potential applicability to marginal and donation after circulatory death hearts.
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Observational Study
Increased incidence of transfusion-related acute lung injury during orthotopic liver transplantation: a short report.
Intractable severe pulmonary edema during Orthotopic Liver Transplant (OLT) can be a fatal perioperative complication. We sought to characterize the incidence, timing, and related risk factors of severe pulmonary edema during OLT. We performed a retrospective observational survey of OLT cases performed between 2007 and 2011 at Miami Transplant Institute. ⋯ Despite a large dose of steroids given at reperfusion, 89% of pulmonary edema episodes occurred within 2.5 hours of reperfusion. Also, heart failure and pulmonary embolism were unlikely based on intraoperative transesophageal echocardiography findings. These results may suggest an association between TRALI and the post reperfusion syndrome during liver transplantation that warrants further investigation.