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

So Hee Jin; Rack Kyung Chung; Jae Hee Woo; Geun Hong

doi:10.12771/emj.2017.40.4.143

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

So Hee Jin, Rack Kyung Chung, Jae Hee Woo, Geun Hong¹

The Ewha Medical Journal 2017;40(4):143-148. Published online: October 31, 2017

DOI: https://doi.org/10.12771/emj.2017.40.4.143

Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, Seoul, Korea.

¹Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea.

Corresponding author: Rack Kyung Chung. Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea. Tel: 82-2-2650-5236, Fax: 82-2-2650-2924, rkchung@ewha.ac.kr

• Received: July 14, 2017 • Revised: September 17, 2017 • Accepted: September 20, 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
References

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.
Keywords: Liver transplantation; Anesthesia; Hospitals, low-volume

References

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.
PubMed
PMC
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.
PubMed
3. Korean Network for Organ Sharing2015 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.
Article
5. Organ Procurement and Transplantation NetworkNational 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.
PubMed
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.
Article
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.
Article
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.
Article
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.
Article
PubMed
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.
Article
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.
Article
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.
Article
14. Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med 2007;357:2601-2614.
Article
PubMed
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.
Article
16. United Network for Organ Sharing2015 Annual data [Internet] Richmond (VA), United Network for Organ Sharing. c2015;cited 2017 Sep 29. Available from: https://www.unos.org/data

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%.

Table 1

Characteristics of recipients

Values are presented as mean±standard deviation (interquartile range) or number.

DD, deceased donor; LD, living donor; MELD, Model for End-stage Liver Disease; LC, liver cirrhosis; HBV, hepatitis B viral; HCV, hepatitis C viral.

^AIndependent t-test was done.

^BChi-square test was done.

^*P<0.05 (LD vs. DD).

Table 2

Operative data

Values are presented as mean±standard deviation (interquartile range) or number (%).

DD, deceased donor; LD, living donor; RBC, red blood cell; FFP, fresh frozen plasma.

^AIndependent t-test was done.

^BChi-square test was done.

^*P<0.05 (LD vs. DD).

Table 3

Postoperative outcomes

Values are presented as mean±standard deviation (interquartile range). All variables analyzed by independent t-test.

DD, deceased donor; LD, living donor; ICU, intensive care unit.

^*P<0.05 (LD vs. DD).

Table 4

Postoperative complications

Values are presented as number of case (percentage of total patient).

CPM, central pontine myelinolysis.