Transplantation proceedings
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Randomized Controlled Trial
Thromboelastography-guided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: randomized clinical trial.
To test in a prospective randomized study the hypothesis that use of thromboelastography (TEG) decreases blood transfusion during major surgery. ⋯ Thromboelastography-guided transfusion decreases transfusion of fresh- frozen plasma in patients undergoing orthotopic liver transplantation, but does not affect 3-year survival.
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Dynamic preload indices such as stroke volume variation (SVV) and pulse pressure variation (PPV) have yielded false-positive results in patients with right ventricular (RV) dysfunction. We therefore assessed the effect of RV dysfunction on dynamic indices to predict the decrease in cardiac output (CO) during liver transplantation. ⋯ These results suggest that dynamic preload indices may not be sufficiently sensitive to detect a CO decrease in liver transplant recipients with RV dysfunction, emphasizing the importance of evaluating RV function when determining the predictability of dynamic indices.
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Patients scheduled for orthotopic liver transplantation (OLT) may have coexisting diseases and more likely receive grafts of poorer quality than in the past. Perioperative mortality and morbidity are usually due to a combination of factors related to the patient, graft, surgery, anesthesia, and intensive care management. Anesthesia and intensive care are the areas with the highest frequency and severity of errors. ⋯ The number of adverse events may be high, but so far no specific programs have been developed to increase patient safety. To improve patient safety, anesthesia and intensive care units must use a proactive approach dedicated to an OLT program. We have presented herein a prevention policy to detect errors before they happen through incident reporting, anonymous and voluntary reports of adverse events or near misses, operating room checklists (patient, drugs, devices, equipment), improved training, safer facilities, equipment function, and adequate drug supplies for an OLT program.
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Correct assessment and follow-up of kidney function is essential in liver transplant recipients. Glomerular filtration rate (GFR) represents the functional capacity of the kidney. The GFR is generally determined on the basis of creatinine clearance using several methods. ⋯ When the preoperative cystatin C concentration exceeded 1.28 mg/L, the postoperative GFR was less than 70 mL/min in the first 5 days after OLT. These findings suggest that if the cystatin C concentration exceeds the cutoff point preoperatively, there will be deterioration of kidney function after OLT. Along with other researchers, we suggest that cystatin C is a sensitive marker of post-OLT kidney function.
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Transcranial Doppler sonography (TCD) provides accurate confirmation of cerebral circulatory arrest (CCA) in brain death (BD), but is not feasible in patients with absent temporal bone windows. We added the transorbital approach in the TCD protocol for the diagnosis of CCA and compared findings with angiography. Furthermore, we evaluated whether reporting the angiographic and sonographic confirmation of CCA to relatives of brain-dead patients improves their comprehension and satisfaction with the medical information. ⋯ The addition of TOD increases the efficacy of TCD in confirming CCA in BD. Reporting confirmation of CCA to families of brain-dead patients may improve their comprehension and satisfaction with the provided medical information.