By Flora Simmons, MD
Liver transplant rates increase after implementation of new organ allocation policy
The OPTN data report is now available and describes key measures of the new liver and intestinal allocation policy for the 18-month period from February 2020 through August 2021. Results show an overall increase in deceased donor liver-alone and liver-kidney transplants, significantly increased transplant rate for sicker patients, and more transplants being performed between 250 and 500 nautical miles, leading to slightly longer median cold ischemic times. Read more here.
Record setting year for heart, liver, and kidney transplants in 2021
For the first time, organ transplants in the United States exceeded 40,000 for a grand total of 41,354 organs transplanted in 2021. There were a total of 24,669 kidney transplants, 9,236 liver transplants, and 3,817 heart transplants. Heart transplants have set a new record for the past 10 consecutive years, while liver transplants have set annual records for the past nine years. Read more here.
DCD Procurement Collaborative Project surpassed goal and recovered DCD donors at a higher rate than the rest of the nation
Twenty-six OPOs from across the country collaborated with the aim to increase the number of DCD donor procurements. Improvement efforts were focused across multiple areas including strengthening relationships between donor hospitals and transplant programs and optimizing clinical practices. The cohort procured 34% more DCD donors in 2021 compared to 26% for the rest of the nation. Read more here.
New relationship with Corey & Associates (PACA)
From Susan Mandell, MD and David Corey, MBA
SATA is excited to announce a new partnership with Corey & Associates (PACA) that will assist with the day-to-day business management of the society’s activities. PACA has worked in the area of management and government relations since 1975, SATA looks forward to working with PACA in order to improve this membership experience. Please find a link to PACA on our webpage here
SATA and SCA Collaboration Update
By Yong G. Peng, MD, PhD, FASE, FASA
With the help of SATA treasurer Dr. Jiapeng Huang preliminary communication, SATA executive council members Drs. Tetsuro Sakai, Jiapeng Huang and Susan Mandell had a Zoom meeting with the Society of Cardiovascular Anesthesiologists (SCA) leadership group. This was a productive discussion covering a wide range of potential collaborations between SCA and SATA.
SCA’s president Dr. Andrew Shaw has fully endorsed Drs. Archer Martin of Mayo Clinic Jacksonville and Sharon McCartney of Duke to become the inaugural Co-Chairs for the Transplant Anesthesia Subcommittee of SCA. Together they will oversee all the projects and progress of collaboration between SATA and SCA.
The initial area of mutual interest will include the following:
- SATA and SCA will exchange a formal Memorandum of Understanding (MOU) to make the collaboration official
- Both organizations recognize the mutual interests including but not limited to: a) data-based research (heart and lung). b) practice guidelines c) advocacy to UNOS
- Both societies leaders also agreed on the importance of structured training and educational process for adult lung transplantation (ALT) anesthesiologists. They will work on the specific logistics to provide TEE training curriculum and competency assessment for ALT anesthesiologists
In response to the call for SATA and SCA collaborations, both SATA’s CT Transplantation Committee and CT Educational Task Force Committee recently had a Zoom meeting to lay out the specific action plans. The committees proposed that SATA has three cardiothoracic related entities (CT transplantation Committee, TEE Work Group and CT Educational Taskforce) working together to consolidate resources and make a collective effort to reach important goals. These include promoting cardiothoracic related missions of SATA to other societies scientific activities, distribution of cardiothoracic transplantation educational materials on the SATA website, hosting regular meetings on relevant cardiothoracic transplant topics to maintain SATA member’s interest, and keeping all three entities member engagement to advance SATA’s clinical and research interest in collaboration with other professional societies.
Research Updates and Interesting Articles
By Michael Trostler, MD
- OPTN/SRTR 2020 Annual Data Report Liver, has been published. This is the first official update from the start of the pandemic. As of June 2020, 98,989 liver transplant recipients were alive. The report is full of interesting information on total numbers, demographics, and outcomes. Read more here
- Does machine perfusion improve immediate and short-term outcomes by enhancing graft function and recipient recovery after liver transplantation? – A systematic review of the literature, meta-analysis and expert panel recommendations
Highlights: Hypothermic machine perfusion decreases post-reperfusion syndrome and early graft dysfunction. Normothermic machine perfusion reduces incidence of post-reperfusion syndrome and early graft dysfunction. Normothermic regional perfusion decreases likelihood of early graft dysfunction and risk of primary non-function. Read more here
- Sequential hypothermic and normothermic machine perfusion enables safe
transplantation of high-risk donor livers
Highlights: Sequential Dual hypothermic oxygenated machine perfusion followed by Normothermic Machine Perfusion (DHOPE-NMP) was used to salvage 63% of originally discarded livers with 1 year graft survival 94%, and patient survival 100%. Read more here
- Liver resection versus liver transplantation for hepatocellular carcinoma within Milan criteria: a meta-analysis of 18,421 patients.
Highlights: Mortality after liver resection is nearly 50% higher than liver transplant in hepatocellular carcinoma. Read more here
Articles of the month from January and February, 2022
By Michael Ander, MD
- Postreperfusion syndrome in liver transplantation: outcomes, predictors, and application for recipient selection
Highlights: Donor age, donor BMI, moderate macrosteatosis, and CIT were identified as risk factors for the development of PRS in LT using DBD grafts. PRS risk evaluation may improve donor-to-recipient matching based on their MELD scores. Read more here
- Is obesity associated with better liver transplant outcomes? A retrospective study of hospital length of stay and mortality following liver transplantation
Highlights: Results provide evidence that overweight and obesity class 1 are associated with decreased length of stay and mortality following liver transplant, while underweight and obesity class 3 are associated with prolonged length of stay. Read more here
In the Spotlight: Houston Methodist Medical Center (Texas Medical Center)
By David Rosenfeld, MD, FASA
For this quarter’s segment we were able to connect with Scott Lindberg, MD, FASA, director of liver transplant anesthesiology at the 900 bed Houston Methodist Medical Center.
Currently Methodist is one of the busiest abdominal programs in the US with 183 livers, 255 kidneys (47% live donor), and 14 pancreas cases completed in 2021. For the liver program nearly all are cadaveric, however they have launched a liver donor program with their first case in October 2021, and a second scheduled in early 2022. Methodist is aggressive in utilizing advanced age/extended criteria grafts with over 20% DCD. They are frequently using the Transmedic normothermic perfusion system and are working to publish their early experience. Nearly all cases are on VV bypass, PA catheter and FloTrac are routine, TEE is placed in nearly 100% of cases with one team member advanced certified. ABG assays are POC in-room. ROTEM is performed in the central lab; however, the tracing is visible in real time in the OR. Antifibrinolytics are given with documented hyperfibrinolysis in conjunction with on field coagulopathy, and in cases when greater than eight units of packed cells are administered. A small percentage of patients are extubated in the operating room.
The most unique aspect of the liver transplant anesthesiology practice is that it is covered exclusively with a dedicated six-physician team from the private practice group US Anesthesia Partners working either as the sole in-room provider or in conjunction with UT Houston anesthesia residents, who rotate late in the CA2 and throughout the CA3 years. Team members carry faculty appointments at the Weill Cornell School of Medicine and/or Texas A&M College of Medicine. This private staffing model is clearly uncommon, and particularly unusual given that the program was the third largest volume US center in 2021. Several years ago, Methodist hired liver transplant anesthesiologist Randolph Steadman, MD, MS, to serve as Chair of Anesthesiology, to lead the hospital-based group, and to increase collaboration between the private and hospital practices. In that vein, in September 2021 the department was accredited for an anesthesiology residency, with Dr. Lindberg of US Anesthesia Partners in the role of program director. It is an exciting time as they recently matched their first class of six categorical residents to begin in July 2022.
The transplant program has made it their mission to expand the donor pool by looking to technology and data to push the boundaries of extended criteria donors. There is also a commitment to increase research activity with the establishment of the residency program.
SATA Virtual Lung Transplant Anesthesia Fellowship Series, April 16, 2022 6:00 PM EST. Dr. Jack Hanley will be interviewed by Dr. Brandi Bottiger exploring a surgeon’s perspective on lung transplantation. Click here for advanced registration. here
SATA East Regional Meeting, DMV Liver Transplant Anesthesia Meeting 2022. Virtual, April 23rd, 2022 8:45am – 12:45 pm EST. Click here for details here
ILTS Annual Meeting May 4 – 7, 2022, Istanbul, Turkey
American Transplant Congress June 4 – 8, 2022, Boston, MA
International Liver Transplant Congress June 22 – 26, 2022
ILTS Perioperative Care in Liver Transplant Meeting, October 21, 2022, New Orleans, LA
The Department of Anesthesiology at McGovern Medical School at UTHealth is seeking applicants for the position of Medical Co-Director of the Transplant Intensive Care Unit (TSICU) at Memorial Hermann Hospital- Texas Medical Center.
The role of the Medical Co-Director is to oversee and integrate all clinical policies and practice standards in close cooperation and collaboration with the Chief of Transplant Surgery, Pulmonary Critical Care Medicine and other collaborating services in the Transplant Service Line. The Medical Co-Director will partner with the Chair of the Department and the Division Chief of Critical Care Medicine to promote a cohesive strategy to enhance patient care, structure educational systems, standardize translational research opportunities and infrastructure where appropriate and promote a culture of clinical excellence. Additionally, the Medical Co-Director will contribute to the transplant anesthesiology team and collaborate with hospital leadership including the Transplant Service line administrative and nursing teams.
- MD/DO or equivalent with Board Certification in Anesthesiology
- Title or experience commensurate with a rank of Assistant Professor or greater
- Fellowship training in an ACGME Accredited Critical Care Medicine program
- Additional fellowship training in transplant anesthesiology is preferred
If interested, please submit your CV and cover letter to:
George Williams, MD, FASA, FCCM, FCCP
Vice Chair for Critical Care Medicine, Department of Anesthesiology
McGovern Medical School at UTHealth