Specifics of anaesthesia and intensive care in organ transplant patients
Authors:
E. Kieslichová
; E. Uchytilová; P. Píza; P. Vychodil
Authors place of work:
Klinika anesteziologie, resuscitace a intenzivní péče, Transplantcentrum, Institut klinické a experimentální medicíny
Published in the journal:
Anest. intenziv. Med., 29, 2018, č. 6, s. 328-337
Category:
Summary
Solid organ transplantation is the only way to treat end-stage organ disease. Survival of the patients with a transplanted organ has improved significantly in the last decades. It has been mainly due to the careful selection of organ transplant candidates from the waiting lists, improved surgical techniques and advances in intensive care and immunosuppressive therapy. This has logically led to an increase in the number of these patients on the follow-up, treated in the emergency departments and admitted to hospitals and intensive care units. The anaesthetic and intensive care management of the transplant recipients is similar to standard practice but there are physiological and pharmacological specific aspects including the adverse effects of immunosuppression, the risk of infection and the risk of rejection which the anaesthetist and the intensivist should consider. One of the most common reasons for hospital admission of the transplanted patients is infection and sepsis, the most common cause of morbidity and mortality in these patients. The cornerstones in the treatment of sepsis are early pathogen identification, infection source control and supportive therapy including temporary withdrawal of the immunosuppressive therapy.
keywords
solid organ transplantation – immunosuppressive therapy – anaesthesia and intensive care, sepsis
Zdroje
1. Bloom RD, Goldberg LR, Wang AY, et al. An overview of solid organ transplantation. Clin Chest Med. 2005;26:529–543.
2. Rana A, Gruessner A, Agopian VG, et al. Survival benefit of solid-organ transplant in the United States. JAMA Surg. 2015;150:252–259.
3. Okidi OO, Van Dellen D, Sobajo C, et al. Kidney transplant recipients requiring critical care admission within one year of transplant. Exp Clin Transplant. 2017;15:40–46.
4. Li AH, Lam NN, Naylor KL, et al. Early hospital readmissions after transplantation: burden, causes, and consequences. Transplantation. 2016;100:713–728.
5. McElroy LM, Schmidt KA, Richards CT, et al. Early postoperative emergency department care of abdominal transplant recipients. Transplantation. 2015;99:1652–1657.
6. Yataco M, Cowell A, David W, et al. Predictors and impacts of hospital readmissions following liver transplantation. Ann Hepatol. 2016;15:356–362.
7. Kuman M. Transplantace solidních orgánů v České republice. Vnitř Lék. 2015;61:741–746.
8. Lischke R., Šimonek J., Pozniak J., et al. Transplantace plic. Rozhl Chir. 2011;90:612–620.
9. Viklicky O, Fronek J, Trunecka P, et al. Organ transplantation in the Czech Republic. Transplantation. 2017;101:2259–2261.
10. Trunecka P, Gerlei Z, Lisik W, et al. Liver transplantation in Central Europe. Clin Exp Hepatol. 2016;2:21–26.
11. Girman P, Saudek F. The IKEM Pancreas and islet transplant program as part of healthcare for type 1 diabetes patients: Retrospective analysis of outcome from 1983 to 2010. Rev Diabet Stud. 2011;8:35–43.
12. Hošková L, Málek I, Melenovský V, et al. 30 let programu transplantace srdce v Institutu klinické a experimentální medicíny v Praze. Vnitř Lék. 2014;60:275–281.
13. Benzimra M, Calligaro GL, Glanville AR. Acute rejection. J Thorac Dis. 2017;9:5440–5457.
14. Tran S. Anesthetic considerations for patients post-organ transplantation. Semin Anesth Periop Med Pain. 2003;22:119–124.
15. Hammel L, Sebranek J, Hevesi Z. The anesthetic management of adult patients with organ transplants undergoing nontransplant surgery. Adv Anesth. 2010;28:211–244.
16. Cajanding R. Immunosuppression following organ transplantation. Part 1: mechanisms and immunosuppressive agents. Br J Nurs. 2018;27:920–927.
17. Holt CD. Overview of Immunosuppressive therapy in solid organ transplantation. Review. Anesthesiol Clin. 2017;35:365–380.
18. Reske AP, Reske AW, Metze M. Complications of immunosuppressive agents therapy in transplant patients. Minerva Anestesiol. 2015;81:1244–1261.
19. Lin S, Cosgrove C. Perioperative management of immunosuppression. Surg Clin North Am. 2006;86:1167–1183.
20. Littlewood K. The immunocompromised adult and surgery. Best Pract Res Clin Anaesthesiol. 2008;22:585–609.
21. Gass AL, Emaminia A, Lanier G. Cardiac transplantation in the new era. Cardiol Rev. 2015;23:182–188.
22. Jurgens PT, Aquilante CL, Page RL 2nd, Ambardekar AV. Perioperative Management of cardiac transplant recipients undergoing noncardiac surgery: Unique challenges created by advancements in care. Semin Cardiothorac Vasc Anesth. 2017;21:235–244.
23. Csete M, Glas K. Anesthesia for organ transplantation. In: Barash P, Cullen B, Stoelting R. Clinical anesthesia. Philadelphia: Lippincott Williams & Wilkins; 2006:1358–1376.
24. Blasco L, Parameshwar J, Vuylsteke A. Anaesthesia for noncardiac surgery in the heart transplant recipient. Curr Opin Anaesthesiol. 2009;22:109–113.
25. Málek I. Péče o nemocné po transplantaci srdce. Interv Akut Kardiol. 2006;5:116–121.
26. Studer SM, Levy RD, McNeil K, Orens JB. Lung transplant outcomes: a review of survival, graft function, physiology, health-related quality of life and cost-effectiveness. Eur Respir J. 2004;24:674–685.
27. Feltracco P, Falasco G, Barbieri S, et al. Anesthetic considerations for nontransplant procedures in lung transplant patients. J Clin Anesth. 2011;23:508–516.
28. European Association for the study of the liver. EASL Clinical Practice Guidelines: Liver transplantation. J Hepatol. 2015;64:433–485.
29. Charlton MR. Improving long-term outcomes after liver transplantation. Clin Liver Dis. 2014;18:717–730.
30. Lim KB, Schiano TD. Long-term outcome after liver transplantation. Mt Sinai J Med. 2012;79:169–189.
31. Viklický O, Tesař V, Dusilová-Sulková S, et al. Transplantace ledviny. In: Doporučené postupy a algoritmy v nefrologii. 1. vyd. Praha: Grada, 2010.
32. Viklický O, Dusilová-Sulková S, Rychlík I, Tesař V. Predialýza. 1. vyd. Praha: Maxdorf, 2013.
33. Keegan M, Plevak D. The transplant recipient for nontransplant surgery. Anesthesiol Clin North America. 2004;22:827–861.
34. Bover J, Bailone L, López-Báez V, et al. Osteoporosis, bone mineral density and CKD-MBD: treatment considerations. J Nephrol. 2017;30:677–687.
35. Stoumpos S, Jardine AG, Mark PB. Cardiovascular morbidity and mortality after kidney transplantation. Transpl Int. 2015;28:10–21.
36. Stites E, Kennealey P, Wiseman AC. Current status of pancreas transplantation. Curr Opin Nephrol Hypertens. 2016;25:563–569.
37. Shapiro AM, Pokrywczynska M, Ricordi C. Clinical pancreatic islet transplantation. Nat Rev Endocrinol. 2017;13:268–277.
38. Knight S, Vogel T, Friend P. Pancreas Transplantation. Surgery. 2014;32:383–388.
39. Stevanovic K, Sabljak V, Toskovic A, et al. Anaesthesia and the patient with diabetes. Diabetes Metab Syndr. 2015;9:177–179.
40. Grant D, Abu–Elmagd K, Mazariegos G, et al. Intestinal Transplant Registry Report: Global activity and trends. Am J Transplant. 2015;15:210–219.
41. Bharadwaj S, Tandon P, Gohel TD, et al. Current status of intestinal and multivisceral transplantation. Gastroenterol Rep. 2017;5:20–28.
42. Oliverius M, Janoušek L, Kudla M, et al. Transplantace tenkého střeva v České republice. Čas Lék Česk. 2017;156:349–354.
43. Herborn J, Parulkar S. Anesthetic Considerations in Transplant Recipients for nontransplant Surgery. Anesthesiol Clin. 2017;35:539–553.
44. Haspot F, Halary FA. Infectious Diseases in Transplantation Report of the 20th Nantes Actualités Transplantation Meeting. Transplantation. 2015;99:2444–2447.
45. Bafi AT, Tomotani DYV, Freitas DGR. Sepsis in solid organ transplant recipient. Schock. 2017;47:12–17.
46. Kalil AC, Dakroub H, Freifeld AG. Sepsis and solid organ transplantation. Curr Drug Targ. 2007;8:533–541.
47. Kieslichová E. Sepsis in the immunocompromised patient. In: Sepsis. 1. vyd. Dover: SM Group, 2016:1–13.
48. Florescu DF, Sandkovsky U, Kalil AC. Sepsis and Challenging Infections in the Immunosuppressed Patient in the Intensive Care Unit. Infect Dis Clin North Am. 2017;31:415–434.
49. Linden PK (2009) Approach to the immunocompromised host with infection in the intensive care unit. Infect Dis N AM. 2009;23:535–556.
Štítky
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineČlánok vyšiel v časopise
Anaesthesiology and Intensive Care Medicine
2018 Číslo 6
Najčítanejšie v tomto čísle
- ERAS in a Czech hospital – Utopia or Reality?
- Specifics of anaesthesia and intensive care in organ transplant patients
- Emergency medicine ultrasound curriculum for emergency medicine physicians
- Administration of 500 ml of normal saline does not result in immediate damage to the endothelial glycocalyx determinable by sublingual microcirculation assessment