Current opinion in organ transplantation
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Curr Opin Organ Transplant · Jun 2010
ReviewTransplantation for acute liver failure: perioperative management.
A number of conditions can lead to acute liver failure. Determining the cause has important prognostic implications that guide decisions regarding the likelihood of spontaneous recovery, or conversely, the need for transplantation. ⋯ Even tertiary care units that specialize in liver disease treat acute liver failure patients infrequently. Knowledge of the latest guidelines and treatment protocols can lead to improved patient care.
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Curr Opin Organ Transplant · Jun 2010
ReviewQuality improvement in transplant anesthesia: which way forward?
Quality improvement efforts are increasingly applied in transplant medicine and are related to graft/patient outcomes and reimbursement from third-party insures. Perioperative care of transplant patients has only recently attracted attention and quality improvement efforts are not well established. ⋯ In order to improve perioperative care of transplant patients, perioperative quality improvement protocols have to be established at transplant centers. These protocols need to include a comprehensive electronic database that can be easily queried, a periodic review of practice pattern based on existing data, and a well established mechanism for necessary practice adjustments.
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Curr Opin Organ Transplant · Jun 2010
ReviewPrevention of parenteral nutrition-associated liver disease: role of omega-3 fish oil.
Parenteral nutrition-associated liver disease (PNALD) is the most severe complication of long-term parenteral nutrition. Its cause remains unclear, although recent studies suggest that the omega-6 polyunsaturated fatty acids in plant oil-based lipid emulsions and the associated phytosterols contribute to the development of hepatotoxicity. In contrast, fish oil-based lipid emulsions are composed mainly of omega-3 polyunsaturated fatty acids and are hypothesized to be hepatoprotective. This review will discuss fish oil-based lipid emulsions in the prevention of PNALD. ⋯ PNALD remains the most severe complication of long-term parenteral nutrition with an unclear pathophysiology. However, the use of a fish oil-based emulsion appears efficacious and hepatoprotective.
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Curr Opin Organ Transplant · Jun 2010
ReviewSodium, potassium and glucose management in organ transplantation.
To present current knowledge about the metabolic management of patients undergoing solid organ transplantation, and potential organ donors. ⋯ In patients undergoing solid organ transplants, sodium management should aim to minimize an acute change in sodium concentration. Vaptans may be of future use in optimizing patients with cirrhosis prior to transplantation. Pending further studies, a perioperative 'middle ground' target glucose of between 140 and 180 mg/dl seems reasonable at this time.
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Curr Opin Organ Transplant · Apr 2010
ReviewThoracic organs: current preservation technology and future prospects; part 1: lung.
The critical organ shortage has forced lung transplant teams to extend their donor criteria, thereby compromising a good early outcome in the recipient. Better preservation solutions for longer storage are welcomed to further reduce incidence of primary graft dysfunction. New ex-vivo techniques to assess and to condition lungs prior to transplantation are hoped to increase the number of available pulmonary grafts. ⋯ New extracellular preservation solutions have contributed in decreasing the incidence of primary graft dysfunction over the last decade leaving more room to extend the donor criteria and ischemic time. Ex-vivo lung perfusion is now on the horizon as a potential method to prolong the preservation time and to resuscitate lungs of inferior quality.