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BACKGROUND Most patients are listed for liver transplant (LT) following extensive workup as outpatients ("conventional evaluation"). Some patients undergo urgent evaluation as inpatients after being transferred to a transplant center ("expedited evaluation"). We hypothesized that expedited patients would have inferior survival due to disease severity at the time of transplant and shorter workup time. METHODS Patients who underwent evaluation for LT at our institution between 2012-2016 were retrospectively reviewed. The expedited and conventional cohorts were defined as above. Living donor LT recipients, combined liver-kidney recipients, acute liver failure patients, and re-transplant patients were excluded. We compared patient characteristics and overall survival between patients who received a transplant following expedited evaluation and those who did not, and between LT recipients based on expedited or conventional evaluation. RESULTS 509 patients were included (110 expedited, 399 conventional). There was no difference in graft or patient survival at one year for expedited versus conventional LT recipients. In multivariable analysis of overall survival, only Donor Risk Index (HR 1.97, CI 1.04-3.73, p = 0.037, per unit increase) was associated with increased risk of death. CONCLUSIONS Patients who underwent expedited evaluation for LT had significant demographic and clinical differences from patients who underwent conventional evaluation, but comparable post-transplant survival. This article is protected by copyright. All rights reserved.

Background Postoperative pain after living donor hepatectomy is significant. Postoperative coagulopathy may limit the use of epidural analgesia, the gold standard for pain control in abdominal surgery. The erector spinae plane block (ESPB) is a novel regional anesthesia technique that has been shown to provide effective analgesia in abdominal surgery. In this study, we examined the effect of continuous ESPB, administered via catheters, on perioperative opioid requirements after right living donor hepatectomies for liver transplantation. Methods We performed a retrospective cohort study in patients undergoing right living donor hepatectomy. Twenty-four patients who received preoperative ESPB were compared to 51 historical controls who did not receive regional anesthesia. The primary endpoint was the total amount of oral morphine equivalents (OMEs) required on the day of surgery and postoperative day (POD) 1. Results Patients in the ESPB group required a lower total amount of OMEs on the day of surgery and POD 1 [141 (107 - 188) mg] compared the control group [293 (220 - 380) mg; P Conclusions The use of continuous ESPB significantly reduced opioid consumption following right living donor hepatectomy. This article is protected by copyright. All rights reserved.

Background During kidney transplantation, intraoperative fluid management can affect post-transplant graft function. It is unclear whether or not central venous pressure (CVP) monitoring is required to guide fluid therapy during kidney transplantation. Methods We compared post-transplant graft function in recipients of living donor kidney transplants between August 2006 and March 2009 based on the use or absence of intraoperative CVP monitoring. Graft function, assessed using the creatinine reduction ratio on postoperative day 2 (CCR2), was evaluated by multivariable linear regression analysis and in a propensity-matched cohort. Results Two-hundred and ninety patients were included in the analysis. Central venous pressure was monitored in 84 patients. (29%) There was no difference in post-transplant graft function, as measured by CCR2, between patients with- and without CVP monitoring in both unadjusted and multivariable adjusted analysis. There were also no statistically significant differences in CCR2, delayed graft function, or 3-month renal function between those monitored with CVP, and those without, in the propensity-matched cohort. Conclusions In this single center analysis, immediate post-transplant renal function was not associated with the use of intraoperative CVP monitoring. This article is protected by copyright. All rights reserved.