https://doi.org/10.1177/1089253217753399
Seminars in Cardiothoracic and
Vascular Anesthesia
2018, Vol. 22(1) 67–80
© The Author(s) 2018
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DOI: 10.1177/1089253217753399
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Noteworthy Literature Series 2017
Introduction
This annual review presents noteworthy publications
regarding the perioperative care for adult patients under-
going abdominal organ transplantation: pancreas, intes-
tine, renal, and liver. In this yearly update, in addition to
focusing on several key articles pertinent to the anesthesi-
ologist caring for patients undergoing abdominal organ
transplantation, we also review highlights from the Organ
Procurement and Transplantation Network/Scientific
Registry of Transplant Recipients annual reports.
Pancreas Transplantation
Cardiovascular Outcomes
Patient and graft survival have steadily increased for all
pancreas transplants both nationally and internationally.
1,2
Simultaneous pancreas kidney transplant (SPK) graft and
patient outcomes continue to improve, supporting com-
bined transplant as a cure option for diabetic patients with
concurrent kidney disease.
2
However, the 2015 Organ
Procurement and Transplantation Network (OPTN)/
Scientific Registry of Transplant Recipients (SRTR) report
highlights lower survival rates in type II diabetic patients
after all types of pancreas transplant, likely secondary to
this group’s older age and comorbidities.
1
Kim et al
3
con-
ducted a large, retrospective National Inpatient Sample
study to evaluate perioperative cardiovascular complica-
tions after SPK, pancreas after kidney transplant (PAK),
and pancreas transplant alone (PTA).
3
Kim’s group
reviewed cardiovascular complications, including acute
myocardial infarction (MI), atrial fibrillation and flutter,
congestive heart failure (CHF), and transient ischemic
attack/stroke in 13 399 pancreas transplants between 2003
and 2012. Recipients who underwent SPK were younger
and had more cardiovascular risk factors, including ane-
mia, hypertension, and previous coronary revasculariza-
tion. The overall rate of cardiovascular complications was
4.9% across all pancreas transplants. The authors demon-
strated a significantly higher rate of stroke and CHF in
SPK recipients compared with PAK/PTA recipients in uni-
variate analysis. This association between SPK and cardio-
vascular complications remained significant in multivariate
analysis (odds ratio [OR] = 1.48; P = .01); driven primarily
by stroke (OR = 13.41; P = .001). In-hospital mortality
was not statistically different between SPK and PAK/PTA
recipients after multivariable adjustment.
3
Uremia is a
well-known independent risk factor for stroke,
4,5
and
patients undergoing SPK are more likely to be uremic than
patients undergoing PAK/PTA.
753399SCV XX X 10.1177/1089253217753399Seminars in Cardiothoracic and Vascular AnesthesiaZerillo et al
research-article 2018
1
The Mount Sinai Medical Center, New York, NY, USA
2
University of Pittsburgh Medical Center, Pittsburgh, PA, USA
Corresponding Author:
Tetsuro Sakai, Department of Anesthesiology, University of Pittsburgh
Medical Center, Pittsburgh, PA 15213, USA.
Email: sakait@upmc.edu
Noteworthy Literature published in 2017
for Abdominal Organ Transplantation
Jeron Zerillo, MD
1
, Natalie K. Smith, MD
1
,
and Tetsuro Sakai, MD, PhD, MHA
2
Abstract
In 2017, we identified more than 400 peer reviewed publications on the topic of pancreas transplantation, more than 500
on intestinal transplantation, more than 4000 on renal transplantation, and more than 4700 on liver transplantation. This
annual review highlights the most pertinent literature for anesthesiologists and critical care physicians caring for patients
undergoing abdominal organ transplantation. We explore a wide range of topics, including risk for and prediction of
perioperative complications, recommendations on perioperative management, economic analyses, and education of the
trainees in abdominal transplantation anesthesia and critical care.
Keywords
review, anesthesiology, transplantation, pancreas, intestine, kidney, liver