Transplantation proceedings
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Comparative Study Observational Study
A Comparison of the Effects of Sevoflurane and Desflurane on Corrected QT Interval Prolongation in Patients Undergoing Living Donor Liver Transplantation: A Prospective Observational Study.
QT interval prolongation has frequently been observed in patients with advanced liver disease. We investigated the influence of inhalation anesthetics on the corrected QT (QTc) interval prolongation during surgery in patients undergoing living-donor liver transplantation. ⋯ In this prospective observational study, there was no significant difference in QTc intervals between sevoflurane and desflurane. QTc intervals increased during intubation and reperfusion relative to preoperative values in patients given either sevoflurane or desflurane.
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Concerns about the adverse effects of hydroxyethyl starch (HES) on renal function have been raised in recent studies involving critically ill patients. We aimed to evaluate the effect of HES on acute kidney injury (AKI) after living donor right hepatectomy. ⋯ Intraoperative administration of HES may not be associated with AKI after living donor hepatectomy. This result can provide useful information on perioperative fluid management in living liver donors.
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Hemostatic and coagulation disorders related to severe liver disease may cause massive bleeding beyond what can be expected from surgical trauma in liver transplantation. Fluid resuscitation and fibrinolysis may aggravate the problem, as plasma fibrinogen decreases in all patients. The objective of this review was to update the criteria for fibrinogen replacement in liver transplantation. ⋯ In liver transplantation, plasma fibrinogen levels are low in most patients during surgery. Fibrinogen administration to correct hypofibrinogenemia has a positive impact on surgical bleeding. However, there is a scarcity of literature about fibrinogen administration; therefore, administration should be adjusted to replace plasma fibrinogen levels in the range of normal and guided by thromboelastometry.
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The use of pretransplantation extracorporeal membrane oxygenation (ECMO) has been considered to be a relative contraindication and a risk factor associated with poor outcomes in lung transplantation. However, with a donor shortage, use of ECMO before transplantation is often unavoidable. This study aimed to review our experiences of lung transplantation outcome with regards to the use of pretransplantation ECMO. ⋯ Use of pretransplantation ECMO did not jeopardize survival-to-discharge and short-term survival rates in our experience. Our result suggests pretransplantation ECMO can provide a chance of receiving lung transplantation to those who were classified as "too sick to be transplanted."
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Multicenter Study Observational Study
Severe Supratentorial Intracerebral Hemorrhage: Factors Related to Brain Death Development.
This study sought to identify clinical variables that may contribute to the development of brain death (BD) in patients with severe supratentorial intracerebral hemorrhage (ICH). ⋯ Certain clinical variables are predictive of an increased risk for BD development after supratentorial ICH. This information would be useful for transplant coordinators, permitting early identification of at-risk patients and increasing the availability of potential donors.