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1. Women Leadership in Liver Transplantation-Results of an International Survey

Author

Marieke de Rosner – van Rosmalen, Dieter Adelmann, Gabriela A. Berlakovich, Claire Francoz, Nazia Selzner, Marina Berenguer, Kymberly D. Watt, Nancy Kwan Man, Patrizia Burra, and Sher-Lu Pai

Subjects
Surgeons, Female, Humans, Leadership, Surveys and Questionnaires, Liver Transplantation, Physicians, Women, Transplantation, Physicians, Women
Abstract

The International Liver Transplantation Society (ILTS) has placed a strong focus on achieving gender equality and equity in liver transplant (LT). We aimed to understand gender distribution in leadership positions among LT physicians around the world and within ILTS.In 2019, the ILTS Equality, Diversity, and Inclusion Committee distributed a survey to obtain granular data on gender and characteristics of transplant physicians as well as those in leadership positions in each center. Additionally, data were collected on the gender composition of the ILTS membership, council, chairpersons, and committees and from the United Network for Organ Sharing.Data were collected from 243 transplant centers. Thirty-two (13.2%) had at least 1 woman as the director of LT, chief of transplant surgery, or chief of transplant hepatology. Of the 243 centers, 133 reported the age and gender of the leadership personnel. Women physicians comprised 152 of the 833 transplant surgeons (18.2%) and 298 of the 935 hepatologists (31.9%). Among the 1331 ILTS physician members, 588 (44.2%) provided gender information in their member profiles, and 155 (26.3%) identified themselves as women. Of the 26 ILTS leadership positions, 7 (26.9%) were held by women.This analysis of worldwide gender distribution in the LT physician workforce showed notable gender disparity in LT leadership around the globe and within the ILTS. These data provide a launching point for promoting and achieving gender equality and equity in LT.

Published
2022

2. Expedited evaluation for liver transplantation: A critical look at processes and outcomes

Author

Hillary J. Braun, Anna Mello, Rishi Kothari, Mignote Yilma, Elaine Ku, Claus U. Niemann, Li Zhang, Mehdi Tavakol, Dieter Adelmann, and Nancy L. Ascher

Subjects
organ allocation, liver allograft function, medicine.medical_specialty, Kidney Disease, medicine.medical_treatment, Clinical Trials and Supportive Activities, Clinical Sciences, Renal and urogenital, Patient characteristics, Liver transplantation, Living donor, Article, Disease severity, Clinical Research, Risk Factors, Internal medicine, Risk index, Living Donors, medicine, Overall survival, Humans, patient characteristics, Retrospective Studies, Transplantation, dysfunction, business.industry, Liver Disease, Graft Survival, Patient survival, Organ Transplantation, Transplant Recipients, Liver Transplantation, Good Health and Well Being, Treatment Outcome, Increased risk, liver allograft function / dysfunction, Surgery, Digestive Diseases, business
Abstract

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.

Published
2021
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3. Organ donor management goals and delayed graft function in adult kidney transplant recipients

Author

Darren Malinoski, Claus U. Niemann, Dieter Adelmann, Rishi Kothari, Roger J. Lewis, and Juliana Tolles

Subjects
Adult, medicine.medical_specialty, Population, Delayed Graft Function, Logistic regression, Kidney transplant, Risk Factors, Internal medicine, medicine, Humans, Imputation (statistics), education, Donor management, Kidney transplantation, Retrospective Studies, Transplantation, education.field_of_study, Kidney, business.industry, Graft Survival, medicine.disease, Kidney Transplantation, Tissue Donors, medicine.anatomical_structure, Case-Control Studies, business, Goals
Abstract

BACKGROUND Delayed graft function (DGF) after kidney transplantation is a common occurrence and correlates with poor graft and patient outcomes. Donor characteristics and care are known to impact DGF. We attempted to show the relationship between achievement of specific donor management goals (DMG) and DGF. METHODS This is a retrospective case-control study using data from 14 046 adult kidney donations after brain death from hospitals in 18 organ procurement organizations (OPOs) which were transplanted to adult recipients between 2012 and 2018. Data on DMG compliance and donor, recipient, and ischemia-related factors were used to create multivariable logistic regression models. RESULTS The overall rate of DGF was 29.4%. Meeting DMGs for urine output and vasopressor use were associated with decreased risk of DGF. Sensitivity analyses performed with different imputation methods, omitting recipient factors, and analyzing multiple time points yielded largely consistent results. CONCLUSIONS The development of DMGs continues to show promise in improving outcomes in the kidney transplant recipient population. Studies have already shown increased kidney utilization in smaller cohorts, as well as other organs, and shown decreased rates of DGF. Additional research and analysis are required to assess interactions between meeting DMGs and correlation versus causality in DMGs and DGF.

Published
2021

4. Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

Author

Grusser L., Keszei A., Coburn M., Rossaint R., Ziemann S., Kowark A, Daniela Filipescu, Sibylle Kozek-Langenecker, Juan V Llau Pitarch, Susan Mallett, Peter Martus, Idit Matot, Jens Meier, Axel Unterrainer, Dieter Adelmann, Daniel von Langen, Petra Innerhofer, Nicole Innerhofer-Pompernigg, Stefan De Hert, Luc De Baerdemaeker, Jurgen van Limmen, Piet Wyffels, Björn Heyse, Margot Vanderlaenen, Maud Beran, David Kahn, Audrey Prospiech, Luc Jamaer, Freya Mulders, Stefan Jacobs, Wannes Baeten, Sofie Platteau, Isabelle Maquoi, Severine Lauwick, Marc Senard, Vincent Ninane, Jean-Pierre Lecoq, Pierre Boveroux, Grégory Hans, Marcel Vercauteren, Brigitte Leva, Benoit Plichon, Vojislav Vujanovič, Ismet Suljevic, Hened Kelle, Denis Gustin, Matea Bogdanovic Dvorscak, Tamara Lupis, Jadranka Pavičić Šarić, Nataša Paklar, Dagmar Oberhofer, Ira Skok, Borana Kirigin, Ikic Visnja, Marina Kresic, Slavica Kvolik, Renatas Krobot, Vladimir Cerny, Jana Striteska, Marcela Bilska, Petr Štourač, Hana Harazim, Olga Smékalová, Martina Kosinová, Jozef Klučka, Rita Pacasová, Kim Ekelund, Indrek Rätsep, Juri Oganjan, Nadezda Smirnova, Peeter Kivik, Juri Karjagin, Alar Rokk, Alar Sõrmus, Bertrand Rozec, Jean-Christophe Rigal, Jean-Pierre Gouraud, Anne-Marie Chupin, Xavier Ambrosi, Laurent Brisard, Sylvie Decagny, Charles Marc Samama, Lionel Lidzborski, Matthieu Boisson, Anne-Laure Arcade, Gilbert Lorre, Peter Rosenberger, Hannah Merz, Ulrich Goebel, Bettina Schnitter, Hartmut Buerkle, Roland Tomasi, Vera von Dossow-Hanfstingl, Florian Brettner, Andreas Bayer, André Gottschalk, Nicolas Jakobs, Mark Coburn, Ana Kowark, Rolf Rossaint, Rita Laufenberg, Marion Ferner, Michael Schuster, Lydia Strys, Susanne Mauff, Kornel Skitek, Ewa Zielinska-Skitek, Gregor Schittek, Andreas Hoeft, Andreas Fleischer, Maria Wittmann, Florian Kessler, Anne Rohner, Peter Kranke, Christian Wunder, Johanna Jokinen, Kristin Budow, Christopher Prasser, Eva Werner, Alina Balandin, Norbert Ahrens, Kai Zacharowski, Patrick Meybohm, Kassiani Theodoraki, George Giokas, Tasoulis Marios-Konstantinos, Ageliki Pandazi, Aikaterini Kyttari, Eygenia Koursoumi, Georgios Anthopoulos, Antonis Andreou, Athanasios Rantis, Dimitrios Valsamidis, Pelagia Klimi, Konstantinos Katsanoulas, Demetrios Korfiotis, Christos Soumelidis, Fotios Papaspyros, Olga Kiskira, Tilemachos Paraskeuopoulos, Donal Buggy, Mortimer Kelleher, Liz Coghlan, Vladimir Verenkin, Anat Cattan, Francesco Bona, Felicino Debernardi, Andrea Cortegiani, Santi Maurizio Raineri, Giuseppe Accurso, Elena Gramigni, Leonardo Cenni, Laura Campiglia, Irene Lorenzi, Maria Grazia Militello, Tamara Biscioni, Andrius Macas, Daiva Apanaviciute, Darius Trepenaitis, Arunas Gelmanas, Diana Bilshiene, Jurate Sipylaite, Gabija Tomkute, Egle Kontrimaviciut, Renatas Tikuisis, Francis Borg, Ion Chesov, Serghei Cobiletchi, Victoria Moghildea, Bas Verdouw, J F van Poorten, Nick van Dasselaar, Marcus Daniel Lance, Britta de Waal, Lucienne Kropman, Peter van Noord, Benedikt Preckel, Lena Koers, Markus W Hollmann, Holger Baumann, Ankie W M M Koopman-van Gemert, Tore Reikvam, Tore Hervig, Kasper Gymoese Berthelsen, Ingvild Hausberg Sørvoll, Mirosław Czuczwar, Michał Borys, Paweł Piwowarczyk, Suzana Parente, Diogo Martins, Gloria Tareco, Ligia Reis, Joana Amaral, Daniel Ferreira, José Manuel Gonçalves Aguiar, Zélia Moreira, Filipa Lagarto, Filipa Pereira, Maria Lina Miranda, Sofia Serra, Alexandre Carrilho, José Pinto, Sandra Dias, Rita Poeria, Filipe Linda, Silvia Pica, Helder Martinho, Francisco Matias, Claudia Alves, Valentina Almeida, Margarida Marques, Emilia Martires, Piedade Gomes, Elizabete Pereira, Joana Jesus, Claudia Carreira, Carlos Seco, Carlos Bento, Helena Vieira, Luciane Pereira, Fernando Pinto, Luisa Silva, Marta Azenha, Maged Zarif, Ana Bernardino, Ana Raimundo, Ana Lopes, Melissa Fernandes, Beatriz Campos, Ana Macedo, Filipe Pinheiro, Sonia Duarte, Alexandra Saraiva, Catia Real, Marilena Alina Paunescu, Alexandru Bogdan Prodan, Mihai Stefan, Cristian Boros, Marius Tifrea, Anca Dragan, Horhota Lucian, Alida Moise, Carmen Arion-Balescu, Natalia Mincu, Viorel Gherghina, Iulia Cindea, Dan Costea, Ravzan Popescu, Dana Tomescu, Ecaterina Scarlatescu, Esenia Calancea, Ruxandra Copotoiu, Sanda Maria Copotoiu, Victoria Barsan, Dan Corneci, Rely Manolescu, Toma Diana, Denisa Nitu, Georgian Popica, Gabriela Droc, Nicoleta Jipa Lavina, Roxana Ciobanasu, Anna Maria Munteanu, Denisa Anastase, Iona Grintescu, Liliana Mirea, Alexandra Manoleli, Ciobanu Elena, Mary Nicoleta Lupu, Madalina Nina Sandu, Bicolae Bacalbasa, Florenta Calarasu, Alexey Grytsan, Andrey Gasenkampf, Alexander Kulikov, Alexander Shmigelsky, Vojislava Nescovic, Rade Vukovic, Uros Petrovic, Milic Veljovic, Dragana Unic-Stojanovic, Gordana Jovanovic, Ivana Kvrgic, Dragana Rakic, Roman Záhorec, Daniel Cintula, Tomas Veselovsky, Katarina Galkova, Jordana Stevikova, Andrea Číková, Zora Flassikova, Anna Dobisova, Jasmina Markovic Bozic, Minca Voje, Andriy Grynyuk, Alenka Spindler Yesel, Sabina Stivan, Peter Poredos, Darja Kasnik, Jasna Uranjek, Raquel Ferrandis, Sofia Machado, Liliana Henao, Tania Moreno, Ana Izquierdo, Carlos Delgado, Angela Camps, Susana Manrique, Alejandro Arbelaez, Pilar Tormos, Helena Serrano, Irene Garcia, Elvira Bisbe Vives, Luís Moltó, Tania Villar, Enrique Moret, Raquel Tolós, Esther Martínez, Misericordia Basora, Beatriz Tena, Roger Pujol, Jorge Vera Bella, Thomas Mallor, Pablo Mondero, Luis Lopez, Francisco Hidalgo, Maria Bermudez Lopez, Ana Velasco, Begona Bascuas, Victoria Moral, Diana Gómez Martinez, Alfredo Merten, J A Fernández, Nadia Diana Kinast, A Font, Maggi Genaro, Emilia Guasch, Fernando Gilsanz, Raul Martinez, Renato Schiraldi, Ever Martinez, Marta Barquero López, Alexo Lopez Alvarez, Yvan Enrique Sanchez Sanchez, Adriana Roman Fernandez, Olalla Varela Garcia, Marian Angeles Orallo Moran, Veronica Gonzalez Monzon, Óscar Sánchez López, David Sanchez Perez, Pablo Molano Diaz, Concepcion Cassinello, Maria Pilar Jubera, Maria Soler Pedrola, Julio Belmonte Cuenca, Sören Söndergaard, Till Rudolph, Kristin Åkeröy, Monir Jawad, Yousif Saeed, Sergej Safonov, Mona Andersson, Jan Wernerman, Suzanne Odeberg-Wernerman, Tommi Blom, Nesil Deger Coskunfirat, Zekiye Bigat, Suat Sanlı, O Koray Coskunfirat, Atilla Ramazanoğlu, Neval Boztug Uz, Ali Emre Camci, Omur Aksoy, Esra Saka, Oguzhan Arun, Sevda Ozkardesler, Dilek Omur, Mert Akan, Zuleyha Kazak Bengisun, Hakan Yılmaz, Perihan Ekmekci, Onur Selvi, Neslihan Alkis, Çiğdem Yıldırım, Başak Ceyda Meço, Zekeriyye Alanoğlu, Sergiy Vorotyntsev, Yevgen Yakymenko, Galina Troyan, Mohammed Alousi, Sarah James, Paula Meale, Ahmed Chishti, Matt Garner, Rita Singh, Nicola Hirschauer, Charley Higham, Andrea Bell, Alistair Cain, Chris Perry, Katy Davies, Claire Leech, Verity Calder, Shaman Jhanji, Varma Sandeep, Karen Simeson, Philip Watt, Nigel Dunk, Rosemary Ferrie, Margaret Wright, Lynn Everett, Andrew Ferguson, Laura Espie, Gail Browne, Matthew Dickinson, Ashok Nair, Deborah Clements, Peter Carvalho, Thomas Collyer, Jens Bolten, Lajos Zsisku, Attila Petri, Mohammed Ramadan, Tracey Ellimah, Martus, Peter, Laufenberg, Rita, Ferner, Marion, Schuster, Michael, Strys, Lydia, Mauff, Susanne, Skitek, Kornel, Zielinska-Skitek, Ewa, Schittek, Gregor, Hoeft, Andreas, Fleischer, Andreas, Matot, Idit, Wittmann, Maria, Kessler, Florian, Rohner, Anne, Kranke, Peter, Wunder, Christian, Jokinen, Johanna, Budow, Kristin, Prasser, Christopher, Werner, Eva, Balandin, Alina, Meier, Jens, Ahrens, Norbert, Zacharowski, Kai, Meybohm, Patrick, Theodoraki, Kassiani, Giokas, George, Marios-Konstantinos, Tasoulis, Pandazi, Ageliki, Kyttari, Aikaterini, Koursoumi, Eygenia, Anthopoulos, Georgios, Unterrainer, Axel, Andreou, Antonis, Rantis, Athanasios, Valsamidis, Dimitrios, Klimi, Pelagia, Katsanoulas, Konstantinos, Korfiotis, Demetrios, Soumelidis, Christos, Papaspyros, Fotios, Kiskira, Olga, Paraskeuopoulos, Tilemachos, Adelmann, Dieter, Buggy, Donal, Kelleher, Mortimer, Coghlan, Liz, Verenkin, Vladimir, Cattan, Anat, Bona, Francesco, Debernardi, Felicino, Cortegiani, Andrea, Raineri, Santi Maurizio, Accurso, Giuseppe, von Langen, Daniel, Gramigni, Elena, Cenni, Leonardo, Campiglia, Laura, Lorenzi, Irene, Militello, Maria Grazia, Biscioni, Tamara, Macas, Andrius, Apanaviciute, Daiva, Trepenaitis, Darius, Gelmanas, Arunas, Innerhofer, Petra, Bilshiene, Diana, Sipylaite, Jurate, Tomkute, Gabija, Kontrimaviciut, Egle, Tikuisis, Renatas, Borg, Francis, Chesov, Ion, Cobiletchi, Serghei, Moghildea, Victoria, Verdouw, Bas, Innerhofer-Pompernigg, Nicole, van Poorten, J. F., van Dasselaar, Nick, Lance, Marcus Daniel, de Waal, Britta, Kropman, Lucienne, van Noord, Peter, Preckel, Benedikt, Koers, Lena, Hollmann, Markus W., Baumann, Holger, De Hert, Stefan, Koopman-van Gemert, Ankie W. M. M., Reikvam, Tore, Hervig, Tore, Berthelsen, Kasper Gymoese, Sørvoll, Ingvild Hausberg, Czuczwar, Mirosław, Borys, Michał, Piwowarczyk, Paweł, Parente, Suzana, Martins, Diogo, De Baerdemaeker, Luc, Tareco, Gloria, Reis, Ligia, Amaral, Joana, Ferreira, Daniel, Gonçalves Aguiar, José Manuel, Moreira, Zélia, Lagarto, Filipa, Pereira, Filipa, Miranda, Maria Lina, Serra, Sofia, van Limmen, Jurgen, Carrilho, Alexandre, Pinto, José, Dias, Sandra, Poeria, Rita, Linda, Filipe, Pica, Silvia, Martinho, Helder, Matias, Francisco, Alves, Claudia, Almeida, Valentina, Wyffels, Piet, Marques, Margarida, Martires, Emilia, Gomes, Piedade, Pereira, Elizabete, Jesus, Joana, Carreira, Claudia, Seco, Carlos, Bento, Carlos, Vieira, Helena, Pereira, Luciane, Heyse, Björn, Pinto, Fernando, Silva, Luisa, Azenha, Marta, Zarif, Maged, Bernardino, Ana, Raimundo, Ana, Lopes, Ana, Fernandes, Melissa, Campos, Beatriz, Macedo, Ana, Vanderlaenen, Margot, Pinheiro, Filipe, Duarte, Sonia, Saraiva, Alexandra, Real, Catia, Paunescu, Marilena Alina, Bogdan Prodan, Alexandru, Stefan, Mihai, Boros, Cristian, Tifrea, Marius, Dragan, Anca, Beran, Maud, Lucian, Horhota, Moise, Alida, Arion-Balescu, Carmen, Mincu, Natalia, Gherghina, Viorel, Cindea, Iulia, Costea, Dan, Popescu, Ravzan, Tomescu, Dana, Scarlatescu, Ecaterina, Kahn, David, Calancea, Esenia, Copotoiu, Ruxandra, Copotoiu, Sanda Maria, Barsan, Victoria, Corneci, Dan, Manolescu, Rely, Diana, Toma, Nitu, Denisa, Popica, Georgian, Droc, Gabriela, Prospiech, Audrey, Jipa Lavina, Nicoleta, Ciobanasu, Roxana, Munteanu, Anna Maria, Anastase, Denisa, Grintescu, Iona, Mirea, Liliana, Manoleli, Alexandra, Elena, Ciobanu, Lupu, Mary Nicoleta, Sandu, Madalina Nina, Jamaer, Luc, Bacalbasa, Bicolae, Calarasu, Florenta, Grytsan, Alexey, Gasenkampf, Andrey, Kulikov, Alexander, Shmigelsky, Alexander, Nescovic, Vojislava, Vukovic, Rade, Petrovic, Uros, Veljovic, Milic, Mulders, Freya, Unic-Stojanovic, Dragana, Jovanovic, Gordana, Kvrgic, Ivana, Rakic, Dragana, Záhorec, Roman, Cintula, Daniel, Veselovsky, Tomas, Galkova, Katarina, Stevikova, Jordana, Číková, Andrea, Jacobs, Stefan, Flassikova, Zora, Dobisova, Anna, Markovic Bozic, Jasmina, Voje, Minca, Grynyuk, Andriy, Spindler Yesel, Alenka, Stivan, Sabina, Poredos, Peter, Kasnik, Darja, Uranjek, Jasna, Baeten, Wannes, Ferrandis, Raquel, Machado, Sofia, Henao, Liliana, Moreno, Tania, Izquierdo, Ana, Delgado, Carlos, Camps, Angela, Manrique, Susana, Arbelaez, Alejandro, Tormos, Pilar, Platteau, Sofie, Serrano, Helena, Garcia, Irene, Bisbe Vives, Elvira, Moltó, Luís, Villar, Tania, Moret, Enrique, Tolós, Raquel, Martínez, Esther, Basora, Misericordia, Tena, Beatriz, Maquoi, Isabelle, Pujol, Roger, Vera Bella, Jorge, Mallor, Thomas, Mondero, Pablo, Lopez, Luis, Hidalgo, Francisco, Bermudez Lopez, Maria, Velasco, Ana, Bascuas, Begona, Moral, Victoria, Lauwick, Severine, Gómez Martinez, Diana, Merten, Alfredo, Fernández, J. A., Kinast, Nadia Diana, Font, A., Genaro, Maggi, Guasch, Emilia, Gilsanz, Fernando, Martinez, Raul, Schiraldi, Renato, Senard, Marc, Martinez, Ever, Barquero López, Marta, Lopez Alvarez, Alexo, Sanchez Sanchez, Yvan Enrique, Roman Fernandez, Adriana, Varela Garcia, Olalla, Orallo Moran, Marian Angeles, Gonzalez Monzon, Veronica, Sánchez López, Óscar, Sanchez Perez, David, Ninane, Vincent, Molano Diaz, Pablo, Cassinello, Concepcion, Pilar Jubera, Maria, Soler Pedrola, Maria, Belmonte Cuenca, Julio, Söndergaard, Sören, Rudolph, Till, Åkeröy, Kristin, Jawad, Monir, Saeed, Yousif, Lecoq, Jean-Pierre, Safonov, Sergej, Andersson, Mona, Wernerman, Jan, Odeberg-Wernerman, Suzanne, Blom, Tommi, Deger Coskunfirat, Nesil, Bigat, Zekiye, Sanlı, Suat, Coskunfirat, O. Koray, Ramazanoğlu, Atilla, Boveroux, Pierre, Boztug Uz, Neval, Camci, Ali Emre, Aksoy, Omur, Saka, Esra, Arun, Oguzhan, Ozkardesler, Sevda, Omur, Dilek, Akan, Mert, Bengisun, Zuleyha Kazak, Yılmaz, Hakan, Hans, Grégory, Ekmekci, Perihan, Selvi, Onur, Alkis, Neslihan, Yıldırım, Çiğdem, Ceyda Meço, Başak, Alanoğlu, Zekeriyye, Vorotyntsev, Sergiy, Yakymenko, Yevgen, Troyan, Galina, Alousi, Mohammed, Vercauteren, Marcel, James, Sarah, Meale, Paula, Chishti, Ahmed, Garner, Matt, Singh, Rita, Hirschauer, Nicola, Higham, Charley, Bell, Andrea, Cain, Alistair, Perry, Chris, Leva, Brigitte, Davies, Katy, Leech, Claire, Calder, Verity, Jhanji, Shaman, Sandeep, Varma, Simeson, Karen, Watt, Philip, Dunk, Nigel, Ferrie, Rosemary, Wright, Margaret, Plichon, Benoit, Everett, Lynn, Ferguson, Andrew, Espie, Laura, Browne, Gail, Dickinson, Matthew, Nair, Ashok, Clements, Deborah, Carvalho, Peter, Collyer, Thomas, Bolten, Jens, Vujanovič, Vojislav, Zsisku, Lajos, Petri, Attila, Ramadan, Mohammed, Ellimah, Tracey, Suljevic, Ismet, Kelle, Hened, Gustin, Denis, Bogdanovic Dvorscak, Matea, Lupis, Tamara, Pavičić Šarić, Jadranka, Paklar, Nataša, Oberhofer, Dagmar, Skok, Ira, Kirigin, Borana, Visnja, Ikic, Kresic, Marina, Kvolik, Slavica, Krobot, Renatas, Cerny, Vladimir, Striteska, Jana, Bilska, Marcela, Filipescu, Daniela, Štourač, Petr, Harazim, Hana, Smékalová, Olga, Kosinová, Martina, Klučka, Jozef, Pacasová, Rita, Ekelund, Kim, Rätsep, Indrek, Oganjan, Juri, Smirnova, Nadezda, Kozek-Langenecker, Sibylle, Kivik, Peeter, Karjagin, Juri, Rokk, Alar, Sõrmus, Alar, Rozec, Bertrand, Rigal, Jean-Christophe, Gouraud, Jean-Pierre, Chupin, Anne-Marie, Ambrosi, Xavier, Brisard, Laurent, Llau Pitarch, Juan V., Decagny, Sylvie, Samama, Charles Marc, Lidzborski, Lionel, Boisson, Matthieu, Arcade, Anne-Laure, Lorre, Gilbert, Rosenberger, Peter, Merz, Hannah, Goebel, Ulrich, Schnitter, Bettina, Mallett, Susan, Buerkle, Hartmut, Tomasi, Roland, von Dossow-Hanfstingl, Vera, Brettner, Florian, Bayer, Andreas, Gottschalk, André, Jakobs, Nicolas, Coburn, Mark, Kowark, Ana, Rossaint, Rolf, Grusser L., Keszei A., Coburn M., Rossaint R., Ziemann S., Kowark A, Daniela Filipescu, Sibylle Kozek-Langenecker, Juan V Llau Pitarch, Susan Mallett, Peter Martus, Idit Matot, Jens Meier, Axel Unterrainer, Dieter Adelmann, Daniel von Langen, Petra Innerhofer, Nicole Innerhofer-Pompernigg, Stefan De Hert, Luc De Baerdemaeker, Jurgen van Limmen, Piet Wyffels, Björn Heyse, Margot Vanderlaenen, Maud Beran, David Kahn, Audrey Prospiech, Luc Jamaer, Freya Mulders, Stefan Jacobs, Wannes Baeten, Sofie Platteau, Isabelle Maquoi, Severine Lauwick, Marc Senard, Vincent Ninane, Jean-Pierre Lecoq, Pierre Boveroux, Grégory Hans, Marcel Vercauteren, Brigitte Leva, Benoit Plichon, Vojislav Vujanovič, Ismet Suljevic, Hened Kelle, Denis Gustin, Matea Bogdanovic Dvorscak, Tamara Lupis, Jadranka Pavičić Šarić, Nataša Paklar, Dagmar Oberhofer, Ira Skok, Borana Kirigin, Ikic Visnja, Marina Kresic, Slavica Kvolik, Renatas Krobot, Vladimir Cerny, Jana Striteska, Marcela Bilska, Petr Štourač, Hana Harazim, Olga Smékalová, Martina Kosinová, Jozef Klučka, Rita Pacasová, Kim Ekelund, Indrek Rätsep, Juri Oganjan, Nadezda Smirnova, Peeter Kivik, Juri Karjagin, Alar Rokk, Alar Sõrmus, Bertrand Rozec, Jean-Christophe Rigal, Jean-Pierre Gouraud, Anne-Marie Chupin, Xavier Ambrosi, Laurent Brisard, Sylvie Decagny, Charles Marc Samama, Lionel Lidzborski, Matthieu Boisson, Anne-Laure Arcade, Gilbert Lorre, Peter Rosenberger, Hannah Merz, Ulrich Goebel, Bettina Schnitter, Hartmut Buerkle, Roland Tomasi, Vera von Dossow-Hanfstingl, Florian Brettner, Andreas Bayer, André Gottschalk, Nicolas Jakobs, Mark Coburn, Ana Kowark, Rolf Rossaint, Rita Laufenberg, Marion Ferner, Michael Schuster, Lydia Strys, Susanne Mauff, Kornel Skitek, Ewa Zielinska-Skitek, Gregor Schittek, Andreas Hoeft, Andreas Fleischer, Maria Wittmann, Florian Kessler, Anne Rohner, Peter Kranke, Christian Wunder, Johanna Jokinen, Kristin Budow, Christopher Prasser, Eva Werner, Alina Balandin, Norbert Ahrens, Kai Zacharowski, Patrick Meybohm, Kassiani Theodoraki, George Giokas, Tasoulis Marios-Konstantinos, Ageliki Pandazi, Aikaterini Kyttari, Eygenia Koursoumi, Georgios Anthopoulos, Antonis Andreou, Athanasios Rantis, Dimitrios Valsamidis, Pelagia Klimi, Konstantinos Katsanoulas, Demetrios Korfiotis, Christos Soumelidis, Fotios Papaspyros, Olga Kiskira, Tilemachos Paraskeuopoulos, Donal Buggy, Mortimer Kelleher, Liz Coghlan, Vladimir Verenkin, Anat Cattan, Francesco Bona, Felicino Debernardi, Andrea Cortegiani, Santi Maurizio Raineri, Giuseppe Accurso, Elena Gramigni, Leonardo Cenni, Laura Campiglia, Irene Lorenzi, Maria Grazia Militello, Tamara Biscioni, Andrius Macas, Daiva Apanaviciute, Darius Trepenaitis, Arunas Gelmanas, Diana Bilshiene, Jurate Sipylaite, Gabija Tomkute, Egle Kontrimaviciut, Renatas Tikuisis, Francis Borg, Ion Chesov, Serghei Cobiletchi, Victoria Moghildea, Bas Verdouw, J F van Poorten, Nick van Dasselaar, Marcus Daniel Lance, Britta de Waal, Lucienne Kropman, Peter van Noord, Benedikt Preckel, Lena Koers, Markus W Hollmann, Holger Baumann, Ankie W M M Koopman-van Gemert, Tore Reikvam, Tore Hervig, Kasper Gymoese Berthelsen, Ingvild Hausberg Sørvoll, Mirosław Czuczwar, Michał Borys, Paweł Piwowarczyk, Suzana Parente, Diogo Martins, Gloria Tareco, Ligia Reis, Joana Amaral, Daniel Ferreira, José Manuel Gonçalves Aguiar, Zélia Moreira, Filipa Lagarto, Filipa Pereira, Maria Lina Miranda, Sofia Serra, Alexandre Carrilho, José Pinto, Sandra Dias, Rita Poeria, Filipe Linda, Silvia Pica, Helder Martinho, Francisco Matias, Claudia Alves, Valentina Almeida, Margarida Marques, Emilia Martires, Piedade Gomes, Elizabete Pereira, Joana Jesus, Claudia Carreira, Carlos Seco, Carlos Bento, Helena Vieira, Luciane Pereira, Fernando Pinto, Luisa Silva, Marta Azenha, Maged Zarif, Ana Bernardino, Ana Raimundo, Ana Lopes, Melissa Fernandes, Beatriz Campos, Ana Macedo, Filipe Pinheiro, Sonia Duarte, Alexandra Saraiva, Catia Real, Marilena Alina Paunescu, Alexandru Bogdan Prodan, Mihai Stefan, Cristian Boros, Marius Tifrea, Anca Dragan, Horhota Lucian, Alida Moise, Carmen Arion-Balescu, Natalia Mincu, Viorel Gherghina, Iulia Cindea, Dan Costea, Ravzan Popescu, Dana Tomescu, Ecaterina Scarlatescu, Esenia Calancea, Ruxandra Copotoiu, Sanda Maria Copotoiu, Victoria Barsan, Dan Corneci, Rely Manolescu, Toma Diana, Denisa Nitu, Georgian Popica, Gabriela Droc, Nicoleta Jipa Lavina, Roxana Ciobanasu, Anna Maria Munteanu, Denisa Anastase, Iona Grintescu, Liliana Mirea, Alexandra Manoleli, Ciobanu Elena, Mary Nicoleta Lupu, Madalina Nina Sandu, Bicolae Bacalbasa, Florenta Calarasu, Alexey Grytsan, Andrey Gasenkampf, Alexander Kulikov, Alexander Shmigelsky, Vojislava Nescovic, Rade Vukovic, Uros Petrovic, Milic Veljovic, Dragana Unic-Stojanovic, Gordana Jovanovic, Ivana Kvrgic, Dragana Rakic, Roman Záhorec, Daniel Cintula, Tomas Veselovsky, Katarina Galkova, Jordana Stevikova, Andrea Číková, Zora Flassikova, Anna Dobisova, Jasmina Markovic Bozic, Minca Voje, Andriy Grynyuk, Alenka Spindler Yesel, Sabina Stivan, Peter Poredos, Darja Kasnik, Jasna Uranjek, Raquel Ferrandis, Sofia Machado, Liliana Henao, Tania Moreno, Ana Izquierdo, Carlos Delgado, Angela Camps, Susana Manrique, Alejandro Arbelaez, Pilar Tormos, Helena Serrano, Irene Garcia, Elvira Bisbe Vives, Luís Moltó, Tania Villar, Enrique Moret, Raquel Tolós, Esther Martínez, Misericordia Basora, Beatriz Tena, Roger Pujol, Jorge Vera Bella, Thomas Mallor, Pablo Mondero, Luis Lopez, Francisco Hidalgo, Maria Bermudez Lopez, Ana Velasco, Begona Bascuas, Victoria Moral, Diana Gómez Martinez, Alfredo Merten, J A Fernández, Nadia Diana Kinast, A Font, Maggi Genaro, Emilia Guasch, Fernando Gilsanz, Raul Martinez, Renato Schiraldi, Ever Martinez, Marta Barquero López, Alexo Lopez Alvarez, Yvan Enrique Sanchez Sanchez, Adriana Roman Fernandez, Olalla Varela Garcia, Marian Angeles Orallo Moran, Veronica Gonzalez Monzon, Óscar Sánchez López, David Sanchez Perez, Pablo Molano Diaz, Concepcion Cassinello, Maria Pilar Jubera, Maria Soler Pedrola, Julio Belmonte Cuenca, Sören Söndergaard, Till Rudolph, Kristin Åkeröy, Monir Jawad, Yousif Saeed, Sergej Safonov, Mona Andersson, Jan Wernerman, Suzanne Odeberg-Wernerman, Tommi Blom, Nesil Deger Coskunfirat, Zekiye Bigat, Suat Sanlı, O Koray Coskunfirat, Atilla Ramazanoğlu, Neval Boztug Uz, Ali Emre Camci, Omur Aksoy, Esra Saka, Oguzhan Arun, Sevda Ozkardesler, Dilek Omur, Mert Akan, Zuleyha Kazak Bengisun, Hakan Yılmaz, Perihan Ekmekci, Onur Selvi, Neslihan Alkis, Çiğdem Yıldırım, Başak Ceyda Meço, Zekeriyye Alanoğlu, Sergiy Vorotyntsev, Yevgen Yakymenko, Galina Troyan, Mohammed Alousi, Sarah James, Paula Meale, Ahmed Chishti, Matt Garner, Rita Singh, Nicola Hirschauer, Charley Higham, Andrea Bell, Alistair Cain, Chris Perry, Katy Davies, Claire Leech, Verity Calder, Shaman Jhanji, Varma Sandeep, Karen Simeson, Philip Watt, Nigel Dunk, Rosemary Ferrie, Margaret Wright, Lynn Everett, Andrew Ferguson, Laura Espie, Gail Browne, Matthew Dickinson, Ashok Nair, Deborah Clements, Peter Carvalho, Thomas Collyer, Jens Bolten, Lajos Zsisku, Attila Petri, Mohammed Ramadan, Tracey Ellimah, Anesthesiology, ACS - Diabetes & metabolism, APH - Quality of Care, ACS - Heart failure & arrhythmias, APH - Global Health, and ACS - Microcirculation

Subjects
Clinical Oncology, Male, Science, Clinical Decision-Making, Cancer Treatment, Surgical and Invasive Medical Procedures, Geographical Locations, Diagnostic Medicine, Outcome Assessment, Health Care, Medicine and Health Sciences, Humans, Blood Transfusion, Prospective Studies, Aged, Aged, 80 and over, Intraoperative Care, Multidisciplinary, Transfusion Medicine, Anemia, Hematology, Clinical Laboratory Sciences, Health Care, Europe, Surgical Oncology, Oncology, Age Groups, Elective Surgical Procedures, People and Places, Medicine, Population Groupings, Female, Geriatric Care, Clinical Medicine, Erythrocyte Transfusion, Research Article
Abstract

PLOS ONE 17(1), e0262110 (2022). doi:10.1371/journal.pone.0262110, Published by PLOS, San Francisco, California, US

Published
2022
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5. 'The use of bilateral continuous erector spinae plane blocks for postoperative analgesia after right‐sided living donor hepatectomy: A feasibility study'

Author

George Zhou, Sakura Kinjo, Mina Khorashadi, Hillary J. Braun, Matthias R. Braehler, Dieter Adelmann, and Nancy L. Ascher

Subjects
Transplantation, business.industry, medicine.medical_treatment, Nerve Block, Retrospective cohort study, Perioperative, Liver transplantation, medicine.disease, Analgesia, Epidural, Opioid, Anesthesia, Living Donors, Clinical endpoint, Coagulopathy, Feasibility Studies, Hepatectomy, Humans, Medicine, business, Retrospective Studies, Abdominal surgery, medicine.drug
Abstract

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.

Published
2021
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6. Profound Intraoperative Hypotension Associated With Transfusion via the Belmont Fluid Management System

Author

Natalie K. Smith, Sang Kim, Bryan Hill, Joanna Miller, Nicolette Schlichting, Dieter Adelmann, Jeron Zerillo, and Samuel DeMaria

Subjects
Adult, Male, Hypotensive transfusion reaction, business.industry, Transfusion Reaction, Retrospective cohort study, Fluid management, Middle Aged, Rapid infusion, Anesthesiology and Pain Medicine, Multicenter study, Anesthesia, Vasoactive, Etiology, Fluid Therapy, Humans, Medicine, Blood Transfusion, Female, Intraoperative Complications, business, Aged, Retrospective Studies, Surgical patients
Abstract

This retrospective observational case series conducted at 2 large academic centers over a 4-year period consists of 15 cases of profound hypotension in surgical patients immediately after initiation of the Belmont Fluid Management System for rapid transfusion of blood products. Halting the infusion and administering vasoactive agents led to resolution of hypotension. Repeat transfusion with the Belmont system resulted in repeat hypotension unless counteracted with vasopressors. No etiology was elucidated. This represents the largest documented association of acute hypotensive transfusion reaction with any rapid infusion system in surgical patients.

Published
2019
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7. Risk factors for early bleeding complications after lung transplantation – a retrospective cohort study

Author

Dieter Adelmann, Johannes Menger, Barbara Steinlechner, Philipp Opfermann, Stefan Koch, Konrad Hoetzenecker, Peter Jaksch, Martin Kurz, and Mohammed Mouhieddine

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Postoperative Hemorrhage, 030230 surgery, Fibrinogen, Logistic regression, 03 medical and health sciences, Fibrinogen levels, Extracorporeal Membrane Oxygenation, 0302 clinical medicine, Risk Factors, Extracorporeal membrane oxygenation, Humans, Medicine, Lung transplantation, Proportional Hazards Models, Retrospective Studies, Transplantation, business.industry, Retrospective cohort study, Middle Aged, Surgery, Cohort, Female, 030211 gastroenterology & hepatology, business, Lung Transplantation, medicine.drug
Abstract

Risk factors for early bleeding complications after lung transplantation are not well described. Our aim was to evaluate coagulation test results and the use of extracorporeal membrane oxygenation as risk factors for bleeding after lung transplantation. We analyzed a single-center cohort of bilateral lung transplants between January 2009 and August 2015. Predictors of severe postoperative bleeding (bleeding requiring reoperation within 48 h of transplantation) were assessed using multivariable logistic regression. The effect of bleeding on survival was assessed using a Cox proportional-hazards model. Twenty-nine (4.5%) of 641 patients experienced severe postoperative bleeding. Postoperative fibrinogen levels (OR = 0.99, 95% CI 0.98-0.995, P = 0.001; per mg/dl increase) and pre- and postoperative use of extracorporeal membrane oxygenation (OR = 14.41% 95% CI 5.4-40.19, P < 0.001 and OR = 4.25, 95% CI 1.0-11.09, P = 0.002, respectively) were associated with an increased risk of severe postoperative bleeding. Severe postoperative bleeding was associated with decreased survival within 60 days after transplantation (adjusted HR = 5.73, 95% CI 2.52-13.02, P < 0.001). Low postoperative fibrinogen levels, and pre- and postoperative use of extracorporeal membrane oxygenation were risk factors for bleeding after lung transplantation.

Published
2019
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8. COVID-19 and Abdominal Transplant: A Stepwise Approach to Practice During Pandemic Conditions

Author

Jun Shoji, Anna Mello, Hillary J. Braun, Claus U. Niemann, Andrew M. Posselt, Francis Y. Yao, Chris E. Freise, Allison B. Webber, Garrett R. Roll, Nancy L. Ascher, Neil Mehta, James M. Gardner, Dieter Adelmann, Sang-Mo Kang, Ryutaro Hirose, Shareef Syed, Peter G. Stock, Sandy Feng, and John P. Roberts

Subjects
2019-20 coronavirus outbreak, Psychoanalysis, Coronavirus disease 2019 (COVID-19), Waiting Lists, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Pneumonia, Viral, 030230 surgery, Medical and Health Sciences, Vaccine Related, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, Biodefense, Pandemic, Humans, Sociology, Viral, Lung, Pandemics, Immunosuppression Therapy, Transplantation, SARS-CoV-2, Prevention, Medical practice, COVID-19, Pneumonia, Organ Transplantation, Original Clinical Science—General, Tissue Donors, Emerging Infectious Diseases, Infectious Diseases, Good Health and Well Being, Practice Guidelines as Topic, Pneumonia & Influenza, Health Resources, 030211 gastroenterology & hepatology, Surgery, Severe acute respiratory syndrome coronavirus, Coronavirus Infections, Stepwise approach, Immunosuppression
Abstract

Author(s): Syed, Shareef M; Gardner, James; Roll, Garrett; Webber, Allison; Mehta, Neil; Shoji, Jun; Adelmann, Dieter; Niemann, Claus; Braun, Hillary J; Mello, Anna; Yao, Francis; Posselt, Andrew; Kang, Sang-Mo; Hirose, Ryutaro; Roberts, John; Feng, Sandy; Ascher, Nancy; Stock, Peter; Freise, Chris | Abstract: BackgroundThe novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) disease has transformed innumerable aspects of medical practice, particularly in the field of transplantation.Main bodyHere we describe a single-center approach to creating a generalizable, comprehensive, and graduated set of recommendations to respond in stepwise fashion to the challenges posed by these conditions, and the underlying principles guiding such decisions.ConclusionsCreation of a stepwise plan will allow transplant centers to respond in a dynamic fashion to the ongoing challenges posed by the COVID-19 pandemic.

Published
2020
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9. The Association Between Vena Cava Implantation Technique and Acute Kidney Injury After Liver Transplantation

Author

Vivienne, Hannon, Rishi P, Kothari, Li, Zhang, Michael P, Bokoch, Rachel, Hill, Garrett R, Roll, Anna, Mello, John R, Feiner, Kathleen D, Liu, Claus U, Niemann, and Dieter, Adelmann

Subjects
Male, Time Factors, Incidence, Graft Survival, Vena Cava, Inferior, Acute Kidney Injury, Middle Aged, Risk Assessment, Liver Transplantation, Treatment Outcome, Risk Factors, Humans, Female, Warm Ischemia, Vascular Surgical Procedures, Glomerular Filtration Rate, Retrospective Studies
Abstract

Acute kidney injury (AKI) after liver transplantation is associated with increased morbidity and mortality. It remains controversial whether the choice of vena cava reconstruction technique impacts AKI.This is a single-center retrospective cohort of 897 liver transplants performed between June 2009 and September 2018 using either the vena cava preserving piggyback technique or caval replacement technique without veno-venous bypass or shunts. The association between vena cava reconstruction technique and stage of postoperative AKI was assessed using multivariable ordinal logistic regression. Causal mediation analysis was used to evaluate warm ischemia time as a potential mediator of this association.The incidence of AKI (AKI stage ≥2) within 48 h after transplant was lower in the piggyback group (40.3%) compared to the caval replacement group (51.8%, P0.001). Piggyback technique was associated with a reduced risk of developing a higher stage of postoperative AKI (odds ratio, 0.49; 95% confidence interval, 0.37-0.65, P0.001). Warm ischemia time was shorter in the piggyback group and identified as potential mediator of this effect. There was no difference in renal function (estimated glomerular filtration rate and the number of patients alive without dialysis) 1 y after transplant.Piggyback technique, compared with caval replacement, was associated with a reduced incidence of AKI after liver transplantation. There was no difference in long-term renal outcomes between the 2 groups.

Published
2020

10. The Impact of Deceased Donor Liver Extraction Time on Early Allograft Function in Adult Liver Transplant Recipients

Author

Shareef Syed, Mehdi Tavakol, Dieter Adelmann, Rishi Kothari, Claus U. Niemann, Garrett R. Roll, and Lyle Burdine

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Operative Time, 030230 surgery, Liver transplantation, Risk Assessment, Graft function, Decision Support Techniques, 03 medical and health sciences, 0302 clinical medicine, Liver Function Tests, Predictive Value of Tests, Risk Factors, medicine, Hepatectomy, Humans, Warm Ischemia, Transplantation, Deceased donor, medicine.diagnostic_test, business.industry, Cold Ischemia, Graft Survival, Middle Aged, Warm ischemia, Tissue Donors, Liver Transplantation, Surgery, Treatment Outcome, Initial phase, Tissue and Organ Harvesting, Operative time, Female, 030211 gastroenterology & hepatology, Adult liver, Primary Graft Dysfunction, business, Liver function tests
Abstract

In liver transplantation, both cold and warm ischemia times are known to impact early graft function. The extraction time is a period during the initial phase of organ cooling which occurs during deceased donor procurement. During this time, the organ is at risk of suboptimal cooling. Whether donor extraction time, the time from donor aortic cross-clamp to removal of the donor organ from the body cavity has an effect on early graft function is not known.We investigated the effect of donor extraction time on early graft function in 292 recipients of liver grafts procured locally and transplanted at our center between June 2012 and December 2016. Early graft function was assessed using the model of early allograft function score in a multivariable regression model including donor extraction time, cold ischemia time, warm ischemia time, donor risk index, and terminal donor sodium.Donor extraction time had an independent effect on early graft function measured by the model of early allograft function score (coefficient, 0.021; 95% confidence interval, 0.007-0.035; P0.01; for each minute increase of donor extraction time). Besides donor extraction time, cold ischemia time, warm ischemia time, and donor risk index had a significant effect on early graft function.We demonstrate an independent effect of donor extraction time on graft function after liver transplantation. Efforts to minimize donor extraction time could improve early graft function in liver transplantation.

Published
2018
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11. Intraoperative Management of Liver Transplant Patients Without the Routine Use of Renal Replacement Therapy

Author

Claus U. Niemann, Andrea Olmos, Mehdi Tavakol, Babak J. Orandi, John Feiner, Garrett R. Roll, Linda L. Liu, Lyle Burdine, Shareef Syed, and Dieter Adelmann

Subjects
Male, medicine.medical_specialty, Hyperkalemia, medicine.medical_treatment, 030230 surgery, Liver transplantation, urologic and male genital diseases, End Stage Liver Disease, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Renal Dialysis, Risk Factors, Humans, Medicine, Renal Insufficiency, Renal replacement therapy, Dialysis, Retrospective Studies, Transplantation, Intraoperative Care, business.industry, Retrospective cohort study, Perioperative, Middle Aged, medicine.disease, Kidney Transplantation, female genital diseases and pregnancy complications, Liver Transplantation, Surgery, Treatment Outcome, Female, 030211 gastroenterology & hepatology, medicine.symptom, Acidosis, business
Abstract

Background Renal failure is common among patients undergoing liver transplantation. Liver allocation based on the model for end-stage liver disease score has increased the number of recipients who require perioperative renal replacement therapy (RRT). Although RRT can be continued intraoperatively, the risks and benefits of intraoperative RRT are not well defined. The aim of this study is to report the intraoperative management of patients with pretransplant renal failure at a transplant center with extremely infrequent utilization of intraoperative RRT. Materials and methods We performed a retrospective analysis of all adult patients undergoing orthotopic liver or simultaneous liver-kidney (SLK) transplantation between June 2009 and December 2015. Patients were divided into 2 groups based on their need for pretransplant RRT. Results A total of 785 patients underwent liver or SLK transplant during the study period. One hundred and seventy-four patients (22.2%) required preoperative dialysis. Only 2 patients required intraoperative RRT. There was no difference in the incidence of acidosis or hyperkalemia between patients who required preoperative dialysis and those who did not. Conclusions We describe the successful management of patients undergoing liver or SLK transplantation almost entirely without the need for intraoperative RRT.

Published
2018
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12. Society for the Advancement of Transplant Anesthesia: Liver Transplant Anesthesia Fellowship—White Paper Advocating Measurable Proficiency in Transplant Specialties Training

Author

Coimbatore Srinivas, Raymond M. Planinsic, Ryan M Chadha, M. Susan Mandell, Sang Kim, Ernesto A. Pretto, Cara Crouch, Jeron Zerillo, Elia Elia, Ramona Nicolau-Raducu, Christopher Wray, and Dieter Adelmann

Subjects
medicine.medical_specialty, education, 030204 cardiovascular system & hematology, Subspecialty, Accreditation, 03 medical and health sciences, 0302 clinical medicine, White paper, Anesthesiology, Humans, Medicine, Anesthesia, Fellowships and Scholarships, Societies, Medical, Specialist care, business.industry, Internship and Residency, Organ Transplantation, Transplantation, surgical procedures, operative, Anesthesiology and Pain Medicine, Education, Medical, Graduate, 030211 gastroenterology & hepatology, Transplant patient, Clinical Competence, Cardiology and Cardiovascular Medicine, business
Abstract

The anesthesia community has openly debated if the care of transplant patients was generalist or specialist care ever since the publication of an opinion paper in 1999 recommended subspecialty training in the field of liver transplantation anesthesia. In the past decade, liver transplant anesthesia has become more complex with a sicker patient population and evolving evidence-based practices. Transplant training is currently not required for accreditation or certification in anesthesiology, and not all anesthesia residency programs are associated with transplant centers. Yet there is evidence that patient outcome is affected by the experience of the anesthesiologist with liver transplants as part of a multidisciplinary care team. Requests for a formal review of the inequities in training opportunities and requirements led the Society for the Advancement for Transplant Anesthesia (SATA) to begin the task of developing post-graduate fellowship training recommendations. In this article, members of the SATA Working Group on Transplant Anesthesia Education present their reasoning for specialized education and conclusions about which pathways can better prepare trainees to care for complex transplant patients.

Published
2017
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13. Thrombin generation in patients with severe thermal injury

Author

Dieter Adelmann, Marion Wiegele, Christoph Krall, Eva Schaden, Daniel Bauer, and Stefan Koch

Subjects
Adult, Male, Critical Care and Intensive Care Medicine, Thrombin generation, Cohort Studies, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Thrombin, Coagulation testing, Medicine, Humans, Thrombophilia, Prospective Studies, Morning, Aged, Thermal injury, business.industry, 030208 emergency & critical care medicine, General Medicine, Middle Aged, Thrombelastography, Coagulation, Point-of-Care Testing, Anesthesia, Hemostasis, Emergency Medicine, Prothrombin Time, Surgery, Female, Partial Thromboplastin Time, Blood Coagulation Tests, business, Burns, Total body surface area, medicine.drug
Abstract

Background Severe burns can induce a hypercoagulable state which is not depicted in conventional coagulation assays. The thrombin generation assay allows global assessment of coagulation and can identify hypercoagulability. We report changes in thrombin generation in patients after severe burn injury. Methods We measured TGA, rotational thrombelastometry and conventional assays in 20 consecutive patients with a total body surface area burned of >20% over a 2-week period: the day after burn trauma (A), the morning after surgical excision of burn wounds (B) and on post-admission days 7 (C) and 14 (D). Results Thrombin generation assay showed a procoagulatory state: there was an increase in the velocity of thrombin generation (increase in time to peak of +13%, increase in velocity index of +22%), and peak amount of thrombin (+25%) between days A and B. All parameters reached their highest levels on day C and returned towards normal on day D. Rotational thrombelastometry showed a hypercoagulable state with an increase in clot firmness and alpha angle. Conventional coagulation tests remained within reference values. Conclusions In the first two weeks following burn, both the thrombin generation assay and rotational thrombelastometry show a hypercoagulable state, while conventional coagulation tests remain normal.

Published
2018

14. Anesthesia for Liver Transplantation

Author

Dieter Adelmann, Michael A. E. Ramsay, and Kate Kronish

Subjects
Liver Cirrhosis, medicine.medical_specialty, Cirrhosis, medicine.medical_treatment, Hypertension, Pulmonary, 030230 surgery, Liver transplantation, Subspecialty, Cold Ischemia Time, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology, Medicine, Humans, Anesthesia, Blood Coagulation, business.industry, End stage liver disease, General Medicine, Blood Coagulation Disorders, Clinical disease, medicine.disease, Liver Transplantation, Anesthesiology and Pain Medicine, Liver, 030211 gastroenterology & hepatology, Vascular Resistance, Liver dysfunction, business, Cardiac Output, High
Abstract

The provision of anesthesia for a liver transplant program requires a dedicated team of anesthesiologists. Liver transplant anesthesiologists must have an understanding of liver physiology and anatomy; the spectrum of clinical disease associated with liver dysfunction; the impact of warm and cold ischemia times, surgical techniques in liver transplantation, and the impact of ischemia-reperfusion syndrome; and optimal practices to protect the liver. The team must provide a 24-hour service, be actively involved in the selection committee process, and stay current with advances in the subspecialty.

Published
2017

15. Caudal anaesthesia under sedation: a prospective analysis of 512 infants and children

Author

A.-M. Machata, Harald Willschke, Oliver Kimberger, D. Latzke, Peter Marhofer, L. Brenner, Dieter Adelmann, and Stephan C. Kettner

Subjects
Male, medicine.medical_specialty, Premedication, Sedation, Conscious Sedation, Nalbuphine, Abdomen, medicine, Humans, Hypnotics and Sedatives, General anaesthesia, Prospective Studies, Child, Propofol, Ropivacaine, business.industry, Infant, Newborn, Infant, Apnea, Surgery, Analgesics, Opioid, Anesthesiology and Pain Medicine, Anesthesia, Feasibility Studies, Midazolam, Female, Median body, medicine.symptom, business, Anesthesia, Caudal, Infant, Premature, medicine.drug
Abstract

Background Caudal anaesthesia is a common procedure for infants and children undergoing subumbilical surgery, mostly performed in conjunction with general anaesthesia. Even if complications are rare, the risk of postoperative apnoea is significant, especially in infants born preterm or operated upon before 46 weeks of post-conceptual age. Caudal block in sedated, spontaneously breathing patients might be a safe alternative. Methods We investigated 512 infants and children. Premedication consisted of midazolam, sedation was induced with i.v. nalbuphine 0.1 mg kg−1 and propofol 1 mg kg−1, and maintained with propofol 5 mg kg−1 h−1 in children, if necessary. Caudal block was performed with ropivacaine 1 ml kg−1 (0.2% or 0.35%). Results Data were obtained from 228 infants and 284 children. Median (IQR) age was 1.3 (0.2, 3.4) yr; median body weight was 10.0 (4.8, 15.3) kg. Two hundred and thirty-three (45.51%) were born preterm and 47 (9.18%) were operated upon before 46 weeks of post-conceptual age. Caudal block was successful in 98.05% and adverse events occurred in 7.03% patients. The incidence of adverse events was not higher in born preterm or operated upon before 46 weeks of post-conceptual age than in term born infants (P=0.35 and 0.35, respectively), or in infants vs children (P=0.61). There was no correlation between the incidence of adverse events and continuous sedation (P=0.07), coexisting diseases (P=0.11), or ASA classification (P=0.33). Conclusions Caudal anaesthesia under sedation is associated with high success rates and a low incidence of adverse events, but requires careful and anticipatory perioperative management.

Published
2010
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16. Central venous pressure monitoring in living donor kidney recipients does not affect immediate graft function: A propensity score analysis

Author

Claus U. Niemann, Elizabeth L. Whitlock, Leonie Bicknell, Dieter Adelmann, Lyle Burdine, John Feiner, and Garrett R. Roll

Subjects
Male, Kidney Disease, 030204 cardiovascular system & hematology, 030230 surgery, Kidney, Kidney Function Tests, Single Center, Graft function, Kidney Failure, Cohort Studies, 0302 clinical medicine, Risk Factors, Living Donors, Medicine, Chronic, Kidney transplantation, Graft Survival, Central venous pressure, Middle Aged, Prognosis, surgical procedures, operative, medicine.anatomical_structure, Anesthesia, Cohort, Female, Glomerular Filtration Rate, Monitoring, Central Venous Pressure, living donor kidney transplantation, Clinical Sciences, Renal and urogenital, Delayed Graft Function, kidney transplantation, Renal function, anesthesia, Article, Perioperative Care, 03 medical and health sciences, Humans, Physiologic, Propensity Score, Monitoring, Physiologic, Transplantation, business.industry, Organ Transplantation, medicine.disease, Kidney Transplantation, Transplant Recipients, Propensity score matching, Kidney Failure, Chronic, Surgery, business, Follow-Up Studies
Abstract

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.

Published
2018
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17. Fibrinogen But Not Factor XIII Deficiency Is Associated With Bleeding After Craniotomy

Author

Christoph Krall, Dieter Adelmann, Eva Schaden, D. A. Klaus, S. Kozek-Langenecker, U. M. Illievich, and Claus G. Krenn

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Coagulation Protein Disorders, Postoperative Hemorrhage, Fibrinogen, Neurosurgical Procedures, Young Adult, Hematoma, Confidence Intervals, Odds Ratio, medicine, Humans, Factor XIII deficiency, Prospective Studies, Risk factor, Craniotomy, Aged, Blood coagulation test, Aged, 80 and over, Factor XIII, Platelet Count, business.industry, Perioperative, Odds ratio, Middle Aged, Afibrinogenemia, medicine.disease, Surgery, Anesthesiology and Pain Medicine, ROC Curve, Anesthesia, Female, Partial Thromboplastin Time, Blood Coagulation Tests, Neurosurgery, business, medicine.drug
Abstract

Background Postoperative haemorrhage in neurosurgery is associated with significant morbidity and mortality. There is controversy whether or not factor XIII (FXIII) deficiency leads to bleeding complications after craniotomy. Decreased fibrinogen levels have been associated with an increased incidence of bleeding complications in cardiac and orthopaedic surgery. The aim of this study was to assess perioperative fibrinogen and FXIII levels in patients undergoing elective intracranial surgery with and without severe bleeding events. Methods Perioperative FXIII and fibrinogen levels were prospectively assessed in 290 patients undergoing elective craniotomy. Patients were divided into two groups according to the presence or absence of severe bleeding requiring surgical revision. Coagulation test results of these groups were compared using Student's t -test. Results The incidence of postoperative severe bleeding was 2.4%. No differences in FXIII levels were observed, but postoperative fibrinogen levels were significantly lower in patients suffering from postoperative haematoma compared with those without postoperative intracranial bleeding complications [237 mg dl −1 (standard deviation, sd 86) vs 170 mg dl −1 ( sd 35), P =0.03]. The odds ratio for postoperative haematoma in patients with a postoperative fibrinogen level below 200 mg dl −1 was 10.02 (confidence interval: 1.19–84.40, P =0.03). Conclusions This study emphasizes the role of fibrinogen as potentially modifiable risk factor for perioperative bleeding in intracranial surgery. Future randomized controlled trials will be essential to identify patients who might benefit from fibrinogen substitution during neurosurgical procedures.

Published
2015
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