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ABSTRACT Liver transplantation is the major treatment for end-stage liver disease. Postoperative care is a great challenge to reduce morbidity and mortality in patients. In this sense, management in the liver ICU allows hemodynamic management, coagulation monitoring, renal support, electrolyte disturbances, respiratory support and early weaning from mechanical ventilation and evaluation of the liver graft. Objective: The present study shows the results of the management of liver transplant patients in 20 years of experience in a transplant center in a low- to middle-income country. Materials and methods: The medical records of 273 adult patients in the ICU in the immediate postoperative liver transplant were reviewed, from March 20, 2000 to November 30, 2020, including the effect of the pandemic caused by COVID-19. Liver-kidney, retransplanted, SPLIT, and domino transplant patients were excluded. Results: The most frequent etiology for LTx was NASH (35%), the mean age was 49 years, MELD Score ranged 15 - 20 (47.5%), 21 - 30 (46%) > 30 (6.2%). ICU pre transplant stay 7%, average ICU stay: 7.8 days. APACHE average admission: 14.9 points. Weaning extubation of 91.8% patients in ICU and Fast Track in 8.2%. The most frequent respiratory complication was atelectasis 56.3%, pneumonia (31.3%); AKI 1 (60.9%), and 11.1% with hemodyalisis support (AKI3). Immunosuppression: Tacrolimus (8.9%). Post-operative ICU mortality was 6.2%. Conclusions: The management of liver transplantation in the ICU is essential to achieve optimal results in patients who present advanced liver disease and require advanced life support in the immediate postoperative period and thus optimize graft survival.
RESUMEN El trasplante de hígado es el principal tratamiento para la enfermedad hepática en etapa terminal. El cuidado postoperatorio es un gran desafío para disminuir la morbimortalidad en los pacientes. En este sentido, el manejo en la UCI hepática permite manejo hemodinámico, monitoreo de coagulación, soporte renal, alteraciones electrolíticas, soporte respiratorio y destete temprano de ventilación mecánica y evaluación del injerto hepático. Objetivo: El presente estudio muestra los resultados del manejo de pacientes trasplantados de hígado en 20 años de experiencia en un centro de trasplante en un país de ingresos bajos a medios. Materiales y métodos: Se revisaron las historias clínicas de 273 pacientes adultos en UCI en el posoperatorio inmediato de trasplante hepático, desde el 20 de marzo de 2000 hasta el 30 de noviembre de 2020, incluyendo el efecto de la pandemia provocada por el COVID-19. Se excluyeron los pacientes con trasplante de hígado-riñón, retrasplantados, SPLIT y dominó. Resultados: La etiología más frecuente para LTx fue NASH (35%), la edad promedio fue de 49 años, MELD Score varió 15 - 20 (47,5%), 21 - 30 (46%) > 30 (6,2%). Estancia pretrasplante en UCI 7%, estancia media en UCI: 7,8 días. Admisión media APACHE: 14,9 puntos. Extubación weaning del 91,8% de los pacientes en UCI y Fast Track en el 8,2%. La complicación respiratoria más frecuente fue atelectasia 56,3%, neumonía (31,3%); FRA 1 (60,9%) y 11,1% con soporte de hemodiálisis (FRA 3). Inmunosupresión: Tacrolimus (8,9%). La mortalidad postoperatoria en la UCI fue del 6,2%. Conclusiones: El manejo del trasplante hepático en UCI es fundamental para lograr resultados óptimos en pacientes que presentan enfermedad hepática avanzada y requieren soporte vital avanzado en el postoperatorio inmediato y así optimizar la supervivencia del injerto.
RESUMEN
Liver transplantation is the major treatment for end-stage liver disease. Postoperative care is a great challenge to reduce morbidity and mortality in patients. In this sense, management in the liver ICU allows hemodynamic management, coagulation monitoring, renal support, electrolyte disturbances, respiratory support and early weaning from mechanical ventilation and evaluation of the liver graft. OBJECTIVE: The present study shows the results of the management of liver transplant patients in 20 years of experience in a transplant center in a low- to middle-income country. MATERIALS AND METHODS: The medical records of 273 adult patients in the ICU in the immediate postoperative liver transplant were reviewed, from March 20, 2000 to November 30, 2020, including the effect of the pandemic caused by COVID-19. Liver-kidney, retransplanted, SPLIT, and domino transplant patients were excluded. RESULTS: The most frequent etiology for LTx was NASH (35%), the mean age was 49 years, MELD Score ranged 15 - 20 (47.5%), 21 - 30 (46%) > 30 (6.2%). ICU pre transplant stay 7%, average ICU stay: 7.8 days. APACHE average admission: 14.9 points. Weaning extubation of 91.8% patients in ICU and Fast Track in 8.2%. The most frequent respiratory complication was atelectasis 56.3%, pneumonia (31.3%); AKI 1 (60.9%), and 11.1% with hemodyalisis support (AKI3). Immunosuppression: Tacrolimus (8.9%). Post-operative ICU mortality was 6.2%. CONCLUSIONS: The management of liver transplantation in the ICU is essential to achieve optimal results in patients who present advanced liver disease and require advanced life support in the immediate postoperative period and thus optimize graft survival.
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COVID-19 , Enfermedad Hepática en Estado Terminal , Trasplante de Hígado , Adulto , COVID-19/epidemiología , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Persona de Mediana Edad , Perú , Estudios RetrospectivosRESUMEN
RESUMEN Introducción : La no función primaria del injerto (NFPI) después del trasplante hepático es la falla aguda del injerto, en ausencia de algún factor causal, como trombosis aguda de arteria hepática o vena porta. Objetivos : Describir las características perioperatorias de los pacientes trasplantados de Hígado que presentaron NFPI en el Departamento de Trasplantes del Hospital Guillermo Almenara Irigoyen. Materiales y métodos : Estudio retrospectivo, descriptivo y transversal. Desde marzo del 2000 a marzo del 2018 se realizaron 249 Trasplantes de hígado. La NFPI fue definida con los criterios de OPTN/UNOS, se manifiesta por aumento de transaminasas (>3 000 UI/ml), coagulopatía (INR >2,5), niveles altos de lactato (>4 mEq/l), PH en acidosis: PH arterial ≤7,30 y/o PH venoso ≤7,25 e inestabilidad hemodinámica que requiere soporte con drogas vasoactivas; puede llevar a la muerte sin retrasplante de emergencia. Resultados : Se diagnosticaron 8 pacientes con NFPI siendo una prevalencia de 3,7% de 216 trasplantes de hígado en adultos, la edad de los receptores fue 51,5±8,45 años, score de MELD basal 13,13±3,8 (rango 6-18). Las características de los donantes, la edad fue 38,5±14,48, todos ABO idénticos al receptor, la distribución geográfica: 7 de Lima metropolitana y 1 en Tacna. La causa de muerte encefálica 75% ACV Hemorrágico y 25% TEC grave. Respecto a factores transoperatorios el TIF 431±143 min [265 - 645 min], y TIC 81,8±46 min [57- 195 min], La estancia en UCI hasta el deceso del paciente fue 11,13±9,3 días (rango 2-31 días), el 12,5% fue retrasplantado. Conclusiones : La prevalencia de NFPI en nuestro centro después del trasplante hepático es 3,7% similar a las series reportadas por otros centros, y se asocia con mortalidad alta sin retrasplante hepático.
ABSTRACT Introduction : The primary nonfunction of the graft (PNF) after liver transplantation is acute graft failure, in the absence of some causal factor, such as acute thrombosis of the hepatic artery or portal vein. Objectives : Describe the perioperative characteristics of Liver transplant patients who presented NFPI in the Transplant Department of the Guillermo Almenara Irigoyen Hospital. Materials and methods : Retrospective, descriptive and cross-sectional study. From March 2000 to March 2018; 249 liver transplants were performed. The PNF was defined with y he criteria of OPTN/UNOS, manifested by increased transaminases (>3,000 UI/ml), coagulopathy (INR >2.5), high lactate levels (>4 mEq/l), PH in acidosis: PH arterial ≤7.30 and/or venous ≤7.25 and hemodynamic instability that requires support with vasoactive drugs. It can lead to death without emergency retransplantation. Results : 8 patient with PNF were diagnosed with a prevalence of 3.7%, the age of recipients was 51.5±8.45 years, the base MELD score 13.13±3.8 (range 6-18). The characteristics of the donors, the age was 38.5±14.48 years, all ABO identical to the recipients, the geographical distribution: 7 of metropolitan Lima and 1 in Tacna. The cause of encephalic death 75% hemorrhagic DCV and 25% severe TEC. Regarding transoperative factors, the CIT 431±143 min [265 - 645 min], and WIT 81.8±46 min [57- 195 min], the stay in the ICU until the death of the patients was 11.13±9.3 days (range 2-31 days), 12.5% was retransplant. Conclusions : The prevalence of PNF after liver transplant in our center is 3.7%. Similar to the series reported by other center, and is associated with high mortality without retransplantation.
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Adulto , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Trasplante de Hígado , Estudios Transversales , Estudios Retrospectivos , Aloinjertos , HospitalesRESUMEN
INTRODUCTION: The primary nonfunction of the graft (PNF) after liver transplantation is acute graft failure, in the absence of some causal factor, such as acute thrombosis of the hepatic artery or portal vein. OBJECTIVES: Describe the perioperative characteristics of Liver transplant patients who presented NFPI in the Transplant Department of the Guillermo Almenara Irigoyen Hospital. MATERIALS AND METHODS: Retrospective, descriptive and cross-sectional study. From March 2000 to March 2018; 249 liver transplants were performed. The PNF was defined with y he criteria of OPTN/UNOS, manifested by increased transaminases (>3,000 UI/ml), coagulopathy (INR >2.5), high lactate levels (>4 mEq/l), PH in acidosis: PH arterial ≤7.30 and/or venous ≤7.25 and hemodynamic instability that requires support with vasoactive drugs. It can lead to death without emergency retransplantation. RESULTS: 8 patient with PNF were diagnosed with a prevalence of 3.7%, the age of recipients was 51.5±8.45 years, the base MELD score 13.13±3.8 (range 6-18). The characteristics of the donors, the age was 38.5±14.48 years, all ABO identical to the recipients, the geographical distribution: 7 of metropolitan Lima and 1 in Tacna. The cause of encephalic death 75% hemorrhagic DCV and 25% severe TEC. Regarding transoperative factors, the CIT 431±143 min [265 - 645 min], and WIT 81.8±46 min [57- 195 min], the stay in the ICU until the death of the patients was 11.13±9.3 days (range 2-31 days), 12.5% was retransplant. CONCLUSIONS: The prevalence of PNF after liver transplant in our center is 3.7%. Similar to the series reported by other center, and is associated with high mortality without retransplantation.
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Trasplante de Hígado , Adulto , Aloinjertos , Estudios Transversales , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
La infección por Strongyloides stercoralis a partir de donantes de órganos es infrecuente, pero cuando se presenta genera diversas complicaciones. Se reportan dos casos de estrongiloidiasis diseminada derivado de un único donante cadavérico en dos receptores de trasplante renal. Ambos pacientes se presentaron con síntomas gastrointestinales y síntomas respiratorios más lesiones dermatológicas en región abdominal. El diagnóstico se basó en el hallazgo de larvas en lavado broncopulmonar, lesiones dermatológicas, y aspirado duodenal. A pesar del manejo con albendazol e ivermectina por vía oral el curso clínico fue fatal en uno de ellos. El segundo paciente recibió precozmente ivermectina por vía subcutánea y sobrevivió con falla intestinal persistente
A Strongyloides stercoralis infection acquired from the donor in a transplant receptor is not a common occurrence, but its complications have been well known. We report two cases of disseminated strongyloidiasis derived from a single cadaveric donor at two renal transplant recipients. Both patients presented gastrointestinal and respiratory symptoms plus dermatological lesions in the abdominal region. The diagnosis was based on the finding of larvae in bronchopulmonary lavage, dermatological lesions, and duodenal aspiration. Despite the oral administration of albendazole and ivermectin, the clinical course was fatal in one of them. The second patient received precociously ivermectin by subcutaneous administration and survived with persistent bowel failure