Ewha Med J.  2017 Oct;40(4):143-148. 10.12771/emj.2017.40.4.143.

Anesthetic Experiences of Liver Transplantation in a New Low Volume Hospital: Ewha Womans University Mokdong Hospital

• Jin SH
• Chung RK
• Woo JH
• Hong G

• KMID: 2393717
• DOI: http://doi.org/10.12771/emj.2017.40.4.143

Abstract

OBJECTIVES
Liver transplantation (LT) is the only treatment for end stage of liver failure. In Korea, annually it has been performed 1,300 cases. Most of LTs are performed in large volumes centers. More than half of centers performing LT in Korea are low volume hospital and started a LT program recently. We present our four-year experiences and outcomes of anesthesia for LT since 2013.
METHODS
Anesthetic and surgical outcomes of 49 consecutive patients who received LT (living donor LT, 21 cases; deceased donor LT, 28 cases) between April 2013 and April 2017 were analyzed retrospectively.
RESULTS
All patients were adult, with the mean age of 53.5±9.2 years. The most common cause of original liver diseases was hepatitis B virus-related liver cirrhosis (40.8%). The mean MELD (Model for End-stage Liver Disease) score was 18.8±10.7. Postreperfusion syndrome was observed in 34.7%, which were all controlled by calcium, norepinephrine, ephedrine and epinephrine. The mean postoperative intensive care unit stay of deceased donor LT recipients (13.6±9.0 days) was significantly longer than that of living donor LT recipients (8.0±3.3 days). There was no intraoperative mortality in patients receiving LT. Thirty-day post-transplant survival rate was 93.8% and 3-year survival rate was 88.6 %. The most common postoperative complication was pneumonia.
CONCLUSION
We have started LT successfully with multidisciplinary team's steady effort. Adaptation and setting up LT protocol, adequate equipment, proper training at established transplant centers are essential to begin a successful LT program.

Keyword

Liver transplantation; Anesthesia; Hospitals, low-volume

MeSH Terms

Adult
Anesthesia
Calcium
Ephedrine
Epinephrine
Female
Hepatitis B
Hospitals, Low-Volume
Humans
Intensive Care Units
Korea
Liver Cirrhosis
Liver Diseases
Liver Failure
Liver Transplantation*
Liver*
Living Donors
Mortality
Norepinephrine
Pneumonia
Postoperative Complications
Retrospective Studies
Survival Rate
Tissue Donors
Calcium
Ephedrine
Epinephrine
Norepinephrine

Figure

• 

  Fig. 1 Overall post-transplant survival rate. Patient post-transplant survival rate was analyzed by Kaplan-Meier. The 30-day survival rate after transplantation was 93.8% and the 3-year survival rate after transplantation was 88.6%.

Reference

1. Starzl TE, Marchioro TL, Vonkaulla KN, Hermann G, Brittain RS, Waddell WR. Homotransplantation of the liver in humans. Surg Gynecol Obstet. 1963; 117:659–676.

2. Kim ST, Kim SJ, Park KW, Suh KS, Jung SE, Ha J, et al. Early experience of liver transplantation at Seoul National University Hospital. Transplant Proc. 1996; 28:1695–1696.

3. Korean Network for Organ Sharing. 2015 Annual data report [Internet]. Cheongju: Korea Centers for Disease Control and Prevention;2016. cited 2017 Sep 29. Available from: http://konos.go.kr.

4. Woo JH, Chung RK, Baik HJ, Kim YJ. Hydrothorax with alveolarpleural fistula mimicking re-expansion pulmonary edema during liver transplantation: a case report. Korean J Anesthesiol. 2015; 68:184–187.

5. Organ Procurement and Transplantation Network. National data [Internet]. Richmond (VA): Organ Procurement and Transplantation Network;cited 2017 Sep 29. Available from: https://optn.transplant.hrsa.gov/data/view-data-reports/national-data.

6. Axelrod DA, Guidinger MK, McCullough KP, Leichtman AB, Punch JD, Merion RM. Association of center volume with outcome after liver and kidney transplantation. Am J Transplant. 2004; 4:920–927.

7. Lee EK, Chang SH, Kim DK, Cheon BS, Hong YS, Kang BJ, et al. Outcomes of early liver transplantation in a hospital that is starting to perform liver transplantation. J Korean Soc Transplant. 2011; 25:184–189.

8. Kim MS, Lee KW, Hwang S, Kwon CH, You YK, Nah YW, et al. Research for modification of emergency status in deceased donor liver allocation: survival analysis of waiting patients for liver transplantation. J Korean Soc Transplant. 2014; 28:59–68.

9. Kamath PS, Kim WR. Is the change in MELD score a better indicator of mortality than baseline MELD score? Liver Transpl. 2003; 9:19–21.

10. Merion RM, Wolfe RA, Dykstra DM, Leichtman AB, Gillespie B, Held PJ. Longitudinal assessment of mortality risk among candidates for liver transplantation. Liver Transpl. 2003; 9:12–18.

11. Fullington NM, Cauley RP, Potanos KM, O'Melia L, Zurakowski D, Bae Kim H, et al. Immediate extubation after pediatric liver transplantation: a single-center experience. Liver Transpl. 2015; 21:57–62.

12. Findlay JY, Jankowski CJ, Vasdev GM, Chantigian RC, Gali B, Kamath GS, et al. Fast track anesthesia for liver transplantation reduces postoperative ventilation time but not intensive care unit stay. Liver Transpl. 2002; 8:670–675.

13. Pirat A, Ozgur S, Torgay A, Candan S, Zeyneloglu P, Arslan G. Risk factors for postoperative respiratory complications in adult liver transplant recipients. Transplant Proc. 2004; 36:218–220.

14. Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007; 357:2601–2614.

15. Ikegami T, Shirabe K, Matono R, Yoshizumi T, Soejima Y, Uchiyama H, et al. Etiologies, risk factors, and outcomes of bacterial pneumonia after living donor liver transplantation. Liver Transpl. 2012; 18:1060–1068.

16. United Network for Organ Sharing. 2015 Annual data [Internet]. Richmond (VA): United Network for Organ Sharing;c2015. cited 2017 Sep 29. Available from: https://www.unos.org/data.