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Oxford Textbook of Transplant Anaesthesia and Critical Care Oxford Textbooks in Anaesthesia Oxford Textbook of Anaesthesia for the Elderly Patient Edited by Chris Dodds, Chandra M. Kumar, and Bernadette Th. Veering Oxford Textbook of Anaesthesia for Oral and Maxillofacial Surgery Edited by Ian Shaw, Chandra M. Kumar, and Chris Dodds Principles and Practice of Regional Anaesthesia, Fourth Edition Edited by Graeme McLeod, Colin McCartney, and Tony Wildsmith Oxford Textbook of Cardiothoracic Anaesthesia Edited by R. Peter Alston, Paul S. Myles, and Marco Ranucci Oxford Textbook of Transplant Anaesthesia and Critical Care Edited by Ernesto A. Pretto, Jr., Gianni Biancofiore, Andre De Wolf, John R. Klinck, Claus Niemann, Andrew Watts, and Peter D. Slinger Free personal online access for 12 months Individual purchasers of this book are also entitled to free personal access to the online edition for 12 months on Oxford Medicine Online (). Please refer to the access token card for instructions on token redemption and access. Online ancillary materials, where available, are noted at the end of the respective chapters in this book. Additionally, Oxford Medicine Online allows you to print, save, cite, email, and share content; download high-resolution figures as Microsoft PowerPoint slides; save often-used books, chapters, or searches; annotate; and quickly jump to other chapters or related material on a mobile-optimized platform. We encourage you to take advantage of these features. If you are interested in ongoing access after the 12-month gift period, please consider an individual subscription or consult with your librarian. Oxford Textbook of Transplant Anaesthesia and Critical Care Editor-in-Chief Ernesto A. Pretto, Jr. Editors Gianni Biancofiore Andre De Wolf John R. Klinck Claus Niemann Andrew Watts Contributing Editor Peter D. Slinger 1 1 Great Clarendon Street, Oxford, OX 2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2015 The moral rights of the authors‌have been asserted First Edition Published in 2015 Impression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2014948994 ISBN 978–0–19–965142–9 Printed in China by Asia Pacific Offset Ltd. Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. Foreword Organ transplantation began with kidney transplantation in the early 1950s and expanded to heart, lung, liver, pancreas, multiviscera, and xenograft transplantation. Its evolution over the past 50 years or so has been dramatic. The experimental stage of organ transplantation (1960–1980) evolved into the developmental stage (1980–1990) and refinement stage (1991–present) with excellent clinical outcomes. This evolution has been made possible by better understanding of the scientific basis of transplantation, which includes immunology and pathophysiology and continuously improving surgical technique and perioperative care. It is noteworthy that the role of anaesthesiologists and intensivists has been vital in its progression, because organ transplantation is a medical field that requires a multidisciplinary approach by dedicated physicians and scientists of all medical fields. I am extremely pleased to witness the publication of the Oxford Textbook of Transplant Anaesthesia and Critical Care edited by Drs Biancofiore, De Wolf, Klinck, Niemann, Pretto, Slinger, and Watts, who are my respected colleagues and experts in the transplantation field. The major strength of this textbook can be found in its comprehensiveness and the inclusion of scientific bases. It begins with the history of organ transplantation and includes ethics, organ donation, and perioperative management of all transplanted organs. The molecular basis of organ transplantation should encourage further exploration in organ preservation, prevention of ischaemic injury, and modulation of rejection phenomena. The book presents many ideas and concepts to guide the future direction of transplant anaesthesiology, critical care and research, a vital issue for further development of organ transplantation. Organ transplantation, particularly the field of anaesthesiology and critical care medicine, was once believed to be a ‘black hole’—an amorphous unknown object with a huge mass absorbing all resources without a trace. We now have a much better understanding of that black hole, and I believe that we are better equipped to explore the unknown universe with the guidance of this textbook. As a long-time anaesthesiologist in the transplantation field, I sincerely appreciate all editors and contributors for their life-time dedication to organ transplantation. Yoogoo Kang, MD Professor, Anesthesiology Director, Hepatic Transplantation Anesthesiology Thomas Jefferson University Preface So the LORD GOD caused a deep sleep to fall upon the man, and he slept; then He took one of his ribs and closed up the flesh at that place —Genesis 2:21 Organ transplantation is a relatively new medical science that has made it possible for patients with an irreversibly damaged organ, and little hope of long-term survival, to receive a replacement organ from another human-being, living or deceased. This ancient idea, once also the purview of science-fiction novels, has become reality, and it is revolutionizing medical care by bringing renewed hope for healing to thousands of patients worldwide, every day. The only limitation to a much wider application of this life-saving technology is the scarcity of suitable organs. The successful and steady evolution of the field of clinical organ transplantation over the past 100 years or so is directly attributable to the multidisciplinary nature and scientific basis of transplant care. In fact, only since 1995 during which time medical technology has made great strides forward have we seen marked improvements in long-term survival, including among recipients of the most complex transplant procedures. In particular, advances in perioperative and critical care management of the transplant recipient have accounted to a great extent for these recent improvements in outcomes. One of those seminal achievements was the initiation by a group of anaesthesiologists and intensive care physicians at the University of Pittsburgh of a multidisciplinary approach to liver transplantation. The first gathering of this group in 1982 was called ‘Anesthesia and Perioperative Care in Liver Transplantation’, which later became the International Liver Transplantation Society (ILTS). In a letter dated 5 August 1993 by Dr Thomas Starzl, a renowned American liver transplant pioneer, to Dr Peter Safar, a critical care medicine pioneer and founding Chairman of the Department of Anesthesiology and Critical Care Medicine at the University of Pittsburgh, who was then director of what is now known as the Safar Center for Resuscitation Research, Starzl wrote: . . . I have always taken pains to point out how what we do would be utterly impossible without the marvelous collaboration of our unselfish colleagues who work in the operating room and slave over these terribly sick patients afterwards. In a much more professionally meaningful but less public way, we have promoted the interests of the anesthesia and ICU physicians by passing the leadership baton onto Kang et  al., for the organization of the International Liver Transplantation Society that will be meeting for the second time this year in Canada. Dr.  Kang’s efforts and those of his intensive care colleagues were responsible for the birth of this very important organization . . . . In the same vein, the American Society of Anesthesiologists (ASA) described the nature of anaesthesia practice for organ transplantation, and those anaesthesiologists and intensivists engaged in its delivery, in the following manner: The complexity of transplant surgeries requires the expertise and specialty of a transplant anesthesiologist who is an integral part of the transplant team. Transplant anesthesiologists have an extensive background in critical care medicine, cardiac anesthesiology and/ or pediatric anesthesiology. This type of anesthesiologist also provides consultation in both the preoperative and intraoperative stages of care. This statement was a first step in the direction of defining the knowledge base, required training and experience, and scope of practice of the ‘transplant anaesthesiologist’. Likewise, a recent ‘landmark’ decision by the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) (the principal government-mandated agency overseeing organ procurement and sharing in the US), in partnership with the ASA Committee on Transplantation, has promulgated guidelines for the qualifications and clinical responsibilities of the director of liver transplant anaesthesia programmes, as follows: The director of liver transplant anesthesia should have one of the following: 1. Fellowship training in Critical Care Medicine, Cardiac Anesthesiology, or a Liver Transplant Fellowship, that includes the peri-operative care of at least 10 liver transplant recipients. 2. Experience in the peri-operative care of at least 20 liver transplant recipients in the operating room, within the last 5 years. Experience acquired during postgraduate residency training does not count for this purpose. viii  preface The director of liver transplant anesthesia has clinical responsibilities that include but are not limited to the following: ◆ Pre-operative assessment of transplant candidates ◆ Participation in candidate selection ◆ Intra-operative ◆ Post-operative management visits ◆ Participation on the Selection Committee ◆ Consultation pre-operatively with subspecialists as needed ◆ Participation in morbidity and mortality (M&M) conferences (UNOS Bylaws) These guidelines provide official recognition that expertly trained anaesthesiologists are critical to optimizing transplant care. The UNOS bylaws endorse transplant anaesthesiologists’ active participation in medical decision-making in all facets of transplant care. We believe these guidelines should not be limited to the care of liver transplant recipients alone but that the benefits of multidisciplinary care and specialized training in transplant anaesthesia will inevitably lead to improved care for all types of organ transplant recipients, as well as organ donors. Other than pain management and critical care medicine, perhaps there is no other subspecialty of anaesthesiology where our involvement has been as important to improved outcomes and as valued by our professional counterparts. Therefore the impetus for a book on ‘Transplant Anaesthesia and Critical Care’ derives from the same spirit of collaboration and collegiality that seeks to affirm the current trend towards greater specialization in transplant anaesthesia and critical care. Specifically, this book attempts to define the normative body of scientific and clinical knowledge, skill, and training that is essential to the expertise of the anaesthesiologist involved in the care of the organ donor as well as the organ transplant recipient. On behalf of the editors, the expectation is that the appearance of this book is timely, relevant, and true to the present state-ofthe-art and that it will bolster the continued development of the burgeoning field of transplant anaesthesia and critical care. As you will see on initial perusal of the table of contents we have taken a holistic approach to the scope of practice of transplant anaesthesia. In so doing we cover in depth many aspects of transplantation of the major organ systems. Moreover, we have assembled a cadre of multidisciplinary transplant experts from several continents that present updated evidence-based information on various topics related to transplantation, including data on organ transplant practices in leading countries, as well as some of the ethical challenges facing the field of organ transplantation today. We hope this book will be well received by the medical and scientific communities and that it will serve as the authoritative reference work in the field, thereby forming the basis for the design of curricula for teaching and training of medical students, anaesthesia residents, transplant anaesthesia fellows, nurse anaesthetists, and attending anaesthesiologists in transplant care. Finally, we believe that the future of transplant anaesthesia relies heavily on discovery. As such we hope this book will provide the reader with key insights into cellular mechanisms of ischaemia–reperfusion injury that will inspire transplant anaesthesiologists to engage in basic and clinical research, and in so doing contribute to the collective advancement of the science of transplantation. Ernesto A. Pretto, Jr., MD, MPH Miami Transplant Institute Contents Abbreviations  xiii Editors  xix Contributors  xxi SEC TION 1 Introduction 1 History of organ transplantation  3 John R. Klinck and Ernesto A. Pretto, Jr. 2 The development of organ donation systems and regulatory bodies in the United States  13 Nikole Neidlinger, Sean Van Slyck, and Daniel M. Bruggebrew 3 Organ donor allocation and transplant logistics: the European perspective  23 Gabriela A. Berlakovich and Thomas Soliman SEC TION 2 Introduction to transplant ethics 4 Acquiring organs ethically: problems and prospects  33 Jamie Lindemann Nelson 5 Organ allocation: a guide for the perplexed  43 Benjamin E. Hippen 6 Ethical issues in transplant tourism and organ commercialism  53 Robin N. Fiore SEC TION 3 The organ donor 7 Neurological determination of death and organ donation  61 Shariq S. Raza, Ali Salim, and Darren J. Malinoski 8 Critical care of the organ donor  69 Matthew B. Bloom, Ali Salim, and Darren J. Malinoski 9 Research in organ donors: future directions  77 Claus Niemann and Andrea Olmos SECTION 4 The scientific basis of organ transplantation 10 Organ resuscitation  87 Ernesto A. Pretto, Jr., Kyota Fukazawa, and Antonello Pileggi 11 Transplant immunology  99 Phillip Ruiz, Junichiro Sageshima, George Burke, Linda Chen, and Gaetano Ciancio 12 Xenotransplantation  111 Kazuhiko Yamada, Joseph Scalea, and Masayuki Tasaki SECTION 5 Kidney and kidney–pancreas 13 Indications, selection, and evaluation of the kidney transplant candidate  125 M. Francesca Egidi and Giuseppe Segoloni 14 Kidney transplantation: perioperative cardiovascular risk and anaesthetic management  131 Livia Pompei, Maria Gabriella Costa, Mauricio Sainz-Barriga, George Burke, and Giorgio Della Rocca 15 Perioperative management of the kidney–pancreas and pancreas transplant recipient  141 Ugo Boggi, George Burke, and Kumar Belani x   contents 16 Critical care of the kidney, pancreas, and kidney–pancreas transplant recipient  153 Martin Birch, Robby Sikka, and Kumar Belani 17 Diabetes mellitus: epidemiology, pathophysiology, and treatment  165 Piero Marchetti, Margherita Occhipinti, Gabriella Amorese, and Ugo Boggi 18 Islet cell transplantation  171 Antonello Pileggi and Camillo Ricordi SEC TION 6  Liver 19 Liver disease: epidemiology, pathophysiology, and medical management  183 Andre De Wolf, Paul Martin, and Hui-Hui Tan 20 Liver transplantation: patient selection, organ allocation, and outcomes  201 Vishal C. Patel and John O’Grady 21 Critical care of the patient with liver disease  211 Andrea De Gasperi, James Y. Findlay, and John R. Klinck 22 Liver transplantation: anaesthesia and perioperative care  223 John R. Klinck and Andre De Wolf 23 Critical care of the liver transplant recipient  239 Samantha Vizzini, Anurag Johri, Faisal Anis, Ernesto A. Pretto, Jr., and William Peruzzi 24 Perioperative management in live liver donor transplantation  251 Anand Sharma, Gyu-Sam Hwang, and Stuart Andrew McCluskey 25 Paediatric liver transplantation: assessment and intraoperative care  259 James Bennett and Peter Bromley 26 Paediatric liver transplantation: critical care  267 Richard Neal and Oliver Bagshaw SEC TION 7 Intestinal and multivisceral 27 Anaesthetic management of adult intestinal and multivisceral transplantation  277 Kyota Fukazawa, Ernesto A. Pretto, Jr., and Seigo Nishida 28 Paediatric intestinal and multivisceral transplantation: indications, selection, and perioperative management  285 Lydia M. Jorge and Obi Ekwenna 29 Critical care of the intestinal and multivisceral transplant recipient  297 Lydia M. Jorge and Haran Fisher SECTION 8 Heart, lung, and heart–lung 30 Perioperative management of the heart transplant recipient  307 Alan Ashworth and Andrew Roscoe 31 Anaesthesia for heart–lung transplantation  315 Marcin Wąsowicz 32 Lung transplantation  321 Derek Rosen, Marcelo Cypel, and Peter D. Slinger 33 Intensive care management of heart, lung, and heart–lung transplant recipients  339 Andrew C. Steel 34 Heart and lung transplantation in the paediatric and neonatal population: the current era  353 Mazen Faden and Elod Szabo SECTION 9 Special considerations 35 Geriatric transplant anaesthesia  371 Fouad G. Souki and Michael C. Lewis 36 Transfusion medicine and organ transplantation  385 Richard Charlewood and Kerry Gunn 37 Coagulation and haemodynamic monitoring  395 Mark Hayman and Andrew Watts 38 Specialized equipment and procedures: blood salvage, rapid infusion systems, and renal replacement therapy  407 Andrew Watts and Kirstin Naguit 39 Anaesthesia for non-transplant surgery in the organ transplant recipient  419 Luz Aguina and Ernesto A. Pretto, Jr.   40 The anaesthetic implications of pregnancy after organ transplantation  429 Katherine G. Hoctor and J. Sudharma Ranasinghe 41 Starting a new organ transplant programme  439 Karina Rando and Gebhard Wagener 42 Quality improvement and data analysis in transplantation  447 Ryutaro Hirose and Justin Parekh Index  451 contents xi Abbreviations 2,3DPG 2,3-diphosphoglycerate 31P-NMR phosphorus-31 nuclear magnetic resonance 6-MWT 6-minute walk test 7DS seventh day syndrome 99TcMAA technetium-99-radiolabelled macro-aggregated albumin A/C assist-control A2ALL Adult to Adult Living Donor Liver Transplantation Cohort Study A–a alveolar–arterial AAA aromatic amino acid AAMR acute antibody-mediated rejection AASLD American Association for the Study of Liver Diseases AAT α1-antitrypsin ABG arterial blood gas ABOi ABO-incompatible ACC American College of Cardiology ACDA acid citrate dextrose solution A ACE angiotensin-converting enzyme ACLF acute-on-chronic liver failure ACO approved combined organs ACS American College of Surgeons ACTH adrenocorticotropic hormone ADA American Diabetes Association ADH antidiuretic hormone ADP adenosine diphosphate AE adverse event AF atrial fibrillation AFP alpha-fetoprotein AHA American Heart Association aHUS atypical haemolytic–uraemic syndrome AICD automatic implantable cardioverter-defibrillator AIDS acquired immunodeficiency syndrome AKBR arterial ketone body ratio AKI acute kidney injury ALF acute liver failure ALG antilymphocyte globulin ALI acute lung injury ALS amyotrophic lateral sclerosis ALT alanine transaminase AMP adenosine monophosphate AMR antibody-mediated rejection ANT adenosine nucleotide translocator AOPO Association of Organ Procurement Organizations APC antigen-presenting cells APRV airway pressure release ventilation aPTT activated partial thromboplastin time AR acute rejection ARB angiotensin-receptor ARDS acute respiratory distress syndrome  ARDSNET Acute Respiratory Distress Syndrome Network ARF acute respiratory failure ASN American Society of Nephrology ASPEN American Society of Parenteral and Enteral Nutrition AST American Society of Transplantation AST aspartate aminotransferase ASTS American Society of Transplant Surgeons ATG antithymocyte globulin ATN acute tubular necrosis ATP adenosine triphosphate AUC area under the curve AV arteriovenous BAL bronchoalveolar lavage BCAA branched-chain amino acid BH Berlin Heart EXCOR® BiPAP bilevel positive airway pressure BIS bispectral index BiVAD biventricular assist device BM bone marrow BMI body mass index BNP brain natriuretic peptide BOB bronchiolitis obliterans BODE body mass, airflow obstruction, dyspnoea, and exercise capacity BSA body surface area BSLTx bilateral sequential lung transplantation/ transplant BUN blood urea nitrogen CABG coronary artery bypass grafting CAD coronary artery disease CAHPS Consumer Assessment of Healthcare Providers and Systems CARS compensatory anti-inflammatory response syndrome xiv   abbreviations CAV CAVH CAVHD CAVHDF CBC CBIG CCO CDC CESAR cardiac allograft vasculopathy continuous arteriovenous haemofiltration continuous arteriovenous haemodialysis continuous arteriovenous haemodiafiltration complete blood count catastrophic brain injury guideline continuous cardiac output Centers for Disease Control and Prevention conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure trial CF cystic fibrosis CFTR cystic fibrosis transmembrane conductance regulator gene cGMP cyclic guanosine monophosphate CHD congenital heart disease CHF congestive heart failure CI cardiac index CIT cold ischaemia time CKD chronic kidney disease CM-AR cell-mediated acute rejection CMP cardiomyopathy CMRO2 cerebral metabolic rate for oxygen CMS Centers for Medicare and Medicaid Services CMV cytomegalovirus CNI calcineurin inhibitor CNS central nervous system CNT National Council of Transplantation CO cardiac output COOLDonor Cooling to Optimize Organ Live in Donor Study COPD chronic obstructive pulmonary disease CPAP continuous positive airway pressure CPB cardiopulmonary bypass CPM central pontine myelinolysis CPP cerebral perfusion pressure CPX cardiopulmonary exercise CR chronic rejection Cr creatinine CRBSI catheter-related bloodstream infection CRRT continuous renal replacement therapy CSF cerebrospinal fluid CT computed tomography CTA computed tomography angiography/angiogram CTLA4-Ig cytotoxic T-lymphocyte antigen-4 immunoglobulin CTP Child–Turcotte–Pugh CUSUM cumulative summation CV cardiovascular CVA cerebrovascular accident CVC central venous catheter CVD cardiovascular disease CVP central venous pressure CVVH continuous venovenous haemofiltration CVVHDF continuous venovenous haemodialysis and filtration CYP3A cytochrome P-450 IIIA DAD diffuse alveolar damage DBD deceased brain donors DCCT Diabetes Control and Complications Trial DCD DCDD DCM DDAVP DGF DI DIC DIOS DLA DLCO donation after circulatory death donation after circulatory determination of death dilated cardiomyopathy 1-desamino-8-D-arginine vasopressin delayed graft function diabetes insipidus disseminated intravascular coagulation distal intestinal obstruction syndrome donor-specific antibodies diffusing capacity of the lungs for carbon monoxide DLTx double-lung transplantation/transplant DMADV define, measure, analyse, design, verify DMAIC define, measure, analyse, improve, control DMG donor management goal DNDD donation/donors after neurological determination of death DNR do not resuscitate DOB delta over baseline DPA dorsal pancreatic artery DR donor–recipient DRESS drug-related eosinophilic syndrome DRI donor risk index DSA donor-specific antibodies DSE dobutamine stress echocardiography DXR delayed xenograft rejection EASD European Association for the Study of Diabetes EASL European Association for the Study of the Liver EBMT European Group for Blood and Marrow Transplantation EBS European Board of Surgery EBV Epstein–Barr virus EC endothelial cell ECD expanded criteria donor ECG electrocardiography ECHO echocardiography ECHOT4 Evaluation of the Efficacy and Safety of Levothyroxine in Brain Death Organ Donors: a Randomized Controlled Trial ECMO extracorporeal membrane oxygenation EC-MPA enteric-coated mycophenolic acid EEG electroencephalography EF ejection fraction EGDT early goal-directed therapy EHR electronic health record EJ external jugular ELITA European Liver and Intestinal Transplant Association ELTR European Liver Transplant Registry EMB endomyocardial biopsy EPTS estimated post-transplant survival ERCP endoscopic retrograde cholangiopancreatography ESA European Society of Anaesthesiologists ESDP Eurotransplant Senior DR-compatible Program ESLD end-stage liver disease ESOT European Society of Organ Transplantation ESP Eurotransplant Senior Program ESPEN European Society for Clinical Nutrition and Metabolism   ESRD end-stage renal disease EU European Union EVLP ex-vivo lung perfusion EVLWi extravascular lung water index FDA Federal Drug Administration FEV forced expiratory volume FFP fresh frozen plasma FGF-1 fibroblast growth factor-1 FIH factor-inhibiting hypoxia-inducible factor FiO2 fraction of inspired oxygen FKBP FK506 binding protein FMS Fluid Management System FPG fasting plasma glucose FRC functional residual capacity FRETEP Renal Graft Function After Treatment with Erythropoetin FSGS focal segmental glomerulosclerosis FSH follicle-stimulating hormone FTc corrected flow time FVC forced vital capacity GABA gamma-aminobutyric acid GAD glutamic acid decarboxylase Gal galactose GalT galactosyltransferase G-CSF granulocyte-colony stimulating factor GEDV global end-diastolic volume GFR glomerular filtration rate GI gastrointestinal GJ gastrojejunostomy GORD gastro-oesophageal reflux disease  GVH graft versus host GVHD graft versus host disease H1N1 influenza A virus type H1N1 H-2 histocompatibility 2 HAART highly active antiviral therapy HAR hyperacute rejection HAT hepatic artery thrombosis HAV hepatitis A virus Hb haemoglobin HBsAg hepatitis B surface antigen HBV hepatitis B virus HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems HCC hepatocellular carcinoma HCM hypertrophic cardiomyopathy HCV hepatitis C virus HD haemodialysis hDAF human decay accelerating factor HDL high-density lipoprotein HE hepatic encephalopathy HELPP haemolysis, elevated liver enzymes, and low platelets HES hydroxyethyl starch HHS Health and Human Services HIF hypoxia-inducible factor HIV human immunodeficiency virus HLA human leucocyte antigen HLHS hypoplastic left heart syndrome hMCP human membrane cofactor protein abbreviations HOPE HIV Organ Policy Equity HPS hepatopulmonary syndrome HRCT high-resolution computed tomography HRQOL Health-Related Quality of Life HRS hepatorenal syndrome HRSA Health Resources and Services Administration HTK histidine–tryptophan–ketoglutarate HTN hypertension HTx heart transplantation/transplant HU high urgency HVG host versus graft HX hypoxanthine I/R ischaemia–reperfusion IA-1 zinc finger protein IA-1 IABP intra-aortic balloon pump IAK islet after kidney IAP intra-abdominal pressure ICAM-1 intercellular adhesion molecule 1 ICG indocyanine green ICP intracranial pressure ICS intraoperative red blood cell salvage ICT intracardiac thrombosis ICU Intensive Care Unit IDF International Diabetes Federation IEq islet equivalents IFG impaired fasting glycaemia IFN-γ³ interferon-gamma Ig immunoglobulin IGT impaired glucose tolerance IHD ischaemic heart disease IJ internal jugular IL interleukin IL-2R interleukin-2 receptor ILTS International Liver Transplantation Society IM intramuscular IMA inferior mesenteric artery IMPDH inosine monophosphate dehydrogenase IMPDH1 inosine 5-monophosphate dehydrogenase 1 IMV inferior mesenteric vein INCORT National Institute of Transplant Coordination INH isoniazid iNO inhaled nitric oxide INOP Iranian Network for Organ Procurement INR International Normalized Ratio IoC index of covariance IPC ischaemic preconditioning IPF initial poor function IPF idiopathic pulmonary fibrosis IS immunosuppressive regimens ISCT International Society for Cellular Therapy ISHLT International Society for Heart and Lung Transplantation ISO International Organization for Standardization ITA islet transplant alone ITBV intrathoracic blood volume ITBVi intrathoracic blood volume index ITCO intermittent thermodilution cardiac output ITx intestinal transplantation/transplant IV intravenous xv xvi   abbreviations IVC inferior vena cava IVIG intravenous immunoglobulin IVS interventricular septum JCV John Cunningham virus JDRFI Juvenile Diabetes Research Foundation International J–E jaundice–encephalopathy JKTNW Japan Kidney Transplant Network JNK c-Jun N-terminal kinase  JOTNW Japan Organ Transplant Network KCC King’s College Criteria KO knockout KTx kidney transplantation LA left atrial LAS lung allocation score LD live donor LDF leucocyte depletion filter LDL low-density lipoprotein LDLT living donor liver transplantation LFA-1 leucocyte function antigen LFT liver function test LH luteinizing hormone LICAGE Liver Intensive Care Group of Europe LiMax maximal enzymatic liver function capacity LPD low potassium dextran LRD living related donor LTx lung transplantation/transplant LV left ventricle LVAD left ventricular assist device LVEDA left ventricular end-diastolic area LVEF left ventricular ejection fraction MA maximum amplitude MAC minimum alveolar concentration MACE major adverse cardiac events MAGE mean amplitude of glycaemic excursions MAP mean systemic arterial pressure MAPK mitogen-activated protein kinase MARS® Molecular Adsorbent Recirculating System Mb megabase MCA middle cerebral artery MCF maximum clot firmness MCP membrane cofactor protein MCT medium chain triglycerides MDRD modification of diet in renal disease MELD Model for End-stage Liver Disease MET mean exercise tolerance MGH Massachusetts General Hospital mHag minor histocompatibility antigen MHC major histocompatibility complex MI myocardial infarction MMF mycophenolate mofetil MMR measles, mumps, and rubella MMRC Modified Medical Research Council MMVTx modified multivisceral transplantation/transplant MOF multi-organ failure MPA mycophenolic acid mPAP mean pulmonary artery pressure MPSC Membership and Professional Standards Committee MPT mitochondrial permeability transition MPTP mitochondrial permeability transition pore MRA magnetic resonance angiography/angiogram MRI magnetic resonance imaging MRSA methicillin-resistant Staphylococcus aureus mTOR mammalian target of rapamycin MVTx multivisceral transplantation/transplant Nabs natural antibodies NAC N-acetyl-cysteine NADPH nicotinamide adenine dinucleotide phosphate NAFLD non-alcoholic fatty liver disease NASH non-alcoholic steatohepatitis NATCO North American Transplant Coordinators Organization NF-κB nuclear factor kappa-light-chain-enhancer of activated B cells NGSP National Glycohemoglobin Standardization Program NHANES National Health and Nutrition Examination Survey NHBD non-heart-beating donor NHL non-Hodgkin lymphoma NHS National Health Service NICE National Institute for Health and Clinical Excellence NIH National Institutes of Health NIRS near-infrared spectroscopy NIV non-invasive ventilation NK natural killer NKT natural killer T NMDA N-methyl-D-aspartate n-NOS nitric oxide synthetase NO– nitric oxide NOTA National Organ Transplant Act NPO nil per os NQF National Quality Forum NSQIP National Surgical Quality Improvement Program NTPR National Transplantation Pregnancy Registry NVASRS National Veterans Administration Surgical Risk Study NYHA New York Heart Association O:E observed to expected OGD oesophagogastroduodenoscopy OGTT oral glucose tolerance test OH– hydroxyl radical OKT3 muromonab-CD3 OLT orthotropic liver transplantation OLV one-lung ventilation ONT Spanish National Transplant Organization OONO– peroxynitrite OPO organ procurement organization OPTN Organ Procurement and Transplantation Network OR operating room OTPD organs transplanted per donor P:F PaO2:FiO2 ratio PA pulmonary artery PAC pulmonary artery catheter PACU post-anaesthesia care unit PAD pulmonary artery diastolic pressure   PAFC pulmonary artery flotation catheter PAH pulmonary artery hypertension PAK pancreas after kidney PAKTx pancreas after kidney transplantation/transplant PaO2 arterial partial pressure of oxygen in arterial blood PAOP pulmonary arterial occlusion pressure PAP pulmonary artery pressure PaCO2 partial pressure of carbon dioxide PAT pancreas alone transplant PAWP pulmonary artery wedge pressure PBC primary biliary cirrhosis PBPC peripheral blood progenitor cells PCA patient-controlled analgesia PCI percutaneous coronary intervention PCMR Pediatric Cardiomyopathy Registry PCP pneumocystis pneumonia PCR polymerase chain reaction PCWP pulmonary capillary wedge pressure PD peritoneal dialysis PDF primary liver dysfunction PDGF platelet-derived growth factor PDK pyruvate dehydrogenase kinase PDSA plan, do, study, act PE pulmonary embolus PedsQL4.0 Pediatric Quality of Life Inventory 4.0 PEEP positive end-expiratory pressure PELD paediatric end-stage liver disease PERV porcine endogenous retrovirus PET positron emission tomography PFO patent foramen oval PG prostaglandin PGD primary graft dysfunction PGNF Primary Graft Non-Function PHD prolyl hydroxylase PHT pulmonary hypertension PHTS Pediatric Heart Transplant Study PICC percutaneous intravenous catheter PICU paediatric intensive care unit Pinsp inspiratory pressure PIP peak inspiratory pressure PLE protein-losing enteropathy PML progressive multifocal leucoencephalopathy PN parenteral nutrition PNF primary non-function PNH paroxysmal nocturnal haemoglobinuria po per os POC point of care POCD postoperative cognitive dysfunction PP pancreatic polypeptide P-PASS preprocurement pancreas allocation suitability score PPH primary pulmonary hypertension PPHTN portopulmonary hypertension ppm parts per million PPV pulse pressure variation PRA panel reactive antibody PRBC packed red blood cell PRN pro re nata PRS postreperfusion syndrome abbreviations PSE portosystemic encephalopathy PSR Program-Specific Report PT prothrombin time PTFE polytetrafluoroethylene PTH parathyroid hormone PTLD post-transplant lymphoproliferative disorder PTT partial thromboplastin time PTxA pancreas transplant alone PV pulmonary vein/venous PVR pulmonary vascular resistance QALY quality-adjusted life expectancy qds four times a day QOL quality of life QOLI quality of life index RA right atrium RAAS renin–angiotensin–aldosterone system RAP right atrial pressure RBC red blood cell RCM restrictive cardiomyopathy RCPCH Royal College of Paediatrics and Child Health RCT randomized clinical trial RE response entropy RFLP restriction fragment length polymorphism RIPCOD Remote Ischemic Preconditioning in Neurological Death Organ Donors RIPCOT Remote Ischemic Preconditioning in Abdominal Organ Transplantation RIS rapid infusion system ROS reactive oxygen species ROTEM® rotational thromboelastometry RRT renal replacement therapy RV right ventricle/ventricular RVAD right ventricular assist device RVSP right ventricular systolic pressure SA sinoatrial SA splenic artery SAC standard acquisition charge SAM systolic anterior motion SATA Society for the Advancement of Transplant Anesthesia SBP spontaneous bacterial peritonitis SBS short bowel syndrome SCD standard criteria donor SCM sternocleidomastoid SCUF slow continuous ultrafiltration ScvO2 central venous oxygen saturation SE state entropy SEOPF Southeast Organ Procurement Foundation SEROPP Southeastern Regional Organ Procurement Program SFSS small-for-size syndrome SIK simultaneous islet–kidney SIMV synchronized intermittent mandatory ventilation SIRS systemic inflammatory response syndrome SjO2 jugular bulb oxygen saturation SjvO2 jugular venous oxygen saturation SKPT simultaneous kidney–pancreas transplant SLA swine leucocyte antigen SLTx single-lung transplantation/transplant xvii xviii   abbreviations SMA SMV SPAD® SPECT SPKTx superior mesenteric artery superior mesenteric vein Single Pass Albumin Dialysis single photon emission computed tomography simultaneous pancreas–kidney transplantation/ transplant SpO2 peripheral capillary oxygen saturation SPRT sequential probability ratio test SREBP sterol regulatory element binding protein SRTR Scientific Registry of Transplant Recipients SVC superior vena cava SvO2 mixed venous oxygen saturation SVR systemic vascular resistance SVV stroke volume variation T1DR type 1 diabetes recurrence T3 tri-iodothyronine T4 thyroxin TACO transfusion-associated circulatory overload TA-GVHD transfusion-associated graft versus host disease TAP transversus abdominis plane TB tuberculosis TCD transcranial Doppler TCR Transplant Candidate Registration Form TEA thoracic epidural anaesthesia TEB transthoracic electrical bioimpedance TED thromboembolic deterrent TEG thromboelastography/gram TEM-A ThromboElastoMeter-Automated TGF-β transforming growth factor β TGH Toronto General Hospital THAM tris(hydroxymethyl)aminomethane THAM tromethamine TIA transient ischaemic attack TIPS transjugular intrahepatic portosystemic shunt TIVA total intravenous anaesthesia TMA thrombotic microangiopathy TNF tumour necrosis factor TOE transoesophageal echocardiography TOF/PA tetralogy of Fallot with pulmonary atresia TOR target of rapamycin TPE therapeutic plasma exchange TPG transpulmonary gradient TPM Transplant Procurement Management TPN total parenteral nutrition TRALI transfusion-related acute lung injury TRF Transplant Recipient Follow-up Form TRICC Transfusion Requirements in Critical Care TRIM transfusion-related immunomodulation TRR Transplant Recipient Registration Form TSH thyroid-stimulating hormone TTE transthoracic echocardiogram TTS the Transplantation Society UAGA Uniform Anatomical Gift Act UCLA University of California, Los Angeles UEMS Union Européenne des Médecins Spécialistes UFR ultrafiltration rate UIP usual interstitial pneumonia UKELD United Kingdom Model for End-Stage Liver Disease UNOS United Network for Organ Sharing USRDS US Renal Data System UTI urinary tract infection UW University of Wisconsin VA Veterans Administration VAD ventricular assist device VA-ECMO venoarterial extracorporeal membrane oxygenation vCJD variant Creutzfeldt–Jakob disease VDAC voltage-dependent anion channels VEGF vascular endothelial growth factor VHA viscoelastic haemostatic assay VO2 peak oxygen consumption VRE vancomycin-resistant Enterococcus VSD ventricular septal defect VT ventricular tachycardia VTE venous thromboembolic VVB venovenous bypass vWF von Willebrand factor WBC white blood cell WHO World Health Organization WIT warm ischaemia time WU Woods Units XD xanthine dehydrogenase XO xanthine oxidase ZnT8 zinc transporter 8 α1AT alpha-1-antitrypsin αFP alpha-fetoprotein γGT serum glutamyl transferase Editors Editor-in-Chief Ernesto A. Pretto, Jr., MD, MPH Professor and Chief Division of Transplant and Vascular Anesthesia Department of Anesthesiology, Perioperative Medicine and Pain Management Miami Transplant Institute University of Miami Leonard M. Miller School of Medicine/Jackson Memorial Hospital Miami Florida USA Editors Gianni Biancofiore, MD Head Anestesia e Rianimazione SSN Azienda Ospedaliera Pisana Ospedale di Cisanello Pisa Italy Andre De Wolf, MD Professor of Anesthesiology Director, Transplant Anesthesiology Service Department of Anesthesiology Feinberg School of Medicine Northwestern University Chicago Illinois USA John R. Klinck, MD, FRCPC, FRCA Consultant in Anaesthesia Division of Perioperative Care Cambridge University Hospitals Cambridge UK Claus Niemann, MD Professor of Anesthesia & Surgery Department of Anesthesia and Perioperative Care Department of Surgery, Division of Transplantation University of California San Francisco California USA Andrew Watts, MD, FANZCA Consultant in Anaesthesia Head of Transplant Anaesthesia Royal Prince Alfred Hospital Sydney Australia Contributing Editor Peter D. Slinger, MD, FRCPC Associate Professor and Staff Anesthesiologist Toronto General Hospital University of Toronto Toronto Canada
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