Research Updates and Interesting Articles
Michael Trostler, MD
Highlights: South Korean study of 398 patients evaluating incidence of post-reperfusion syndrome in a propofol vs sevoflurane anesthetic, found a statistically significant decrease in the sevoflurane group.
Highlights: Bariatric surgery was able to be performed safely, pre-transplant, simultaneously with transplant, or post-transplant with no increase in adverse events related to the bariatric procedure. Bariatric surgery leads to weight loss and decreased comorbidities in this patient population.
Highlights: The new trend of machine perfusion in organ transplantation is at the forefront of transplantation and extended criteria organs. Porcine model of intestinal transplant has been shown to be viable and successful.
Highlights: A review article of 9 studies including 2000 patients shows no increase in disease free survival, HCC recurrence or impaired overall survival. If cell salvage is desired, it should not be immediately disregarded as an option just because of a hepatocellular carcinoma diagnosis.
Highlights: After a peak in living donor liver transplants in 2001 there was a fall, but there has been a steady rise from 2011 to 2019. There have been improvements in transplant survival over the years with a significantly decreased mortality over the past few years compared to the first few years.
In the Spotlight: Saint Louis University Medical Center Transplant Program
For this quarter’s segment, we connected with Dr. Govind Rangrass, MD, Director of Transplant Anesthesia and Director of Quality/Patient Safety at the new 400-bed SSM Health/Saint Louis University Hospital (SLUH).
Saint Louis University has a long history with abdominal transplant, at one time being one of the busiest transplant centers in the country. In recent years, their volumes have hovered between 30-40 liver transplants/year. SLUH recently merged with the SSM Health, a large hospital network, and as its only transplant center, the program is gearing up for an increase in transplant evaluations and referrals and is carefully navigating the listing process for high-risk patients.
As part of the selection process, the transplant anesthesia director sits on the Liver Recipient Selection Committee. A unique aspect of their program is that they have a separate High Risk Cardiac Evaluation Meeting, which meets weekly to discuss candidates with complex cardiac disease who may benefit from additional pre transplant work-up optimization and ensure postoperative continuity of care with the cardiology team. One of their transplant faculty was the corresponding author of the newly released AHA Scientific Statement on Coronary Heart Disease Screening in Kidney and Liver Transplantation Candidates published in Circulation. Between 2019-2021, patients undergoing liver transplantation at SSM Health/SLUH had 100% survival at one month and 94% survival at one year post transplant.
Their program is one of the few that uses alternative portal flow in transplant for patients with portal vein thrombosis using reno-portal (connecting left renal vein of recipient to donor portal vein to act as inflow) and gastro-portal (using left gastric vein as inflow) anastomoses. Another unique aspect of the program is the disproportionately high number of hepatitis C positive donor livers utilized (~20%). Their program is gaining more experience with the Transmedic normothermic perfusion pumps, which it intends to continue using in the future.
TEG 6S is routinely used and available and housed in the hospital coagulation lab, with a real time tracing available in the operating room. Venovenous bypass is used selectively for redo liver transplants, patients with portopulmonary hypertension with RV dysfunction or hepatopulmonary syndrome, and high MELD patients on preoperative CRRT. Heparin (50U/kg) is administered for hypercoagulable patients prior to caval cross-clamping, and antifibrinolytics are administered as a bolus during the anhepatic stage. Octreotide infusions (50mcg bolus followed by 100mcg/hr) are routinely run for patients with significant portal hypertension.
The SSM Health/SLUH transplant program hosts a robust outcomes research center and has multiple grant-funded research projects. Examples include a study on biomarkers of kidney function to predict perioperative acute kidney injury; a normothermic perfusion basic science lab studying pharmacologic tools to reduce ischemia reperfusion injury in discarded human livers placed on perfusion pumps; and a $1.8 million grant in conjunction with Missouri University of Science and Technology to develop artificial intelligence driven decision-making tools for organ allocation.
The Accessibility and Inclusion Committee
The SATA Council is pleased to announce the introduction of The Accessibility and Inclusion Committee. The Committee will help develop SATA policies by providing the Council with their views on how to ensure members have equal access to all service opportunities within the organization, All SATA members are invited to nominate themselves or a colleague to serve on this new important committee as part of the society leadership. Please send your nominations to the SATA Secretary: Lorenzo De Marchi at email@example.com
Service: Appointment by SATA Council
Term: 2 years; can be renewed
Requirements: SATA Membership in good standing
Purpose: Oversight and Advocacy Committee
Seed Grant Funding Mechanism
The SATA Seed Grant is a one-year $5,000 transplant project starter grant, open to junior faculty members and trainee physician members of the Society. The grant aims to inspire and assist aspiring faculty/trainee physicians who have yet to receive any previous funding to start a transplant-related project. The grant requires the recipient to submit a support letter from the mentoring faculty and the Department Chairperson.
November 1, 2022 – Announcement of the grant
December 1, 2022 – Opening of the submission site
February 28, 2023 – Closure of submission site
April 1, 2023 – Announcement of the awardee and send letters of feedback to the other applicants
April 17, 2023 – Grant presentation at SATA National Meeting in Denver, CO
July 1, 2023 – Grant initiation
December 31, 2023 – submission of the mid-term report
June 30, 2023 – submission of the final report
Click here to review the SATA Seed Grant Grading
Click here to review the SATA Seed Grant Proposal
Transplant Anesthesia Upcoming Meetings
Southeastern SATA Regional Meeting: November 5, 2022
SATA West Meeting: December 10, 2022, San Francisco – in person and hybrid.
Submit an Abstract by email to: Dieter.Adelmann@ucsf.edu
Mid-Western SATA Regional Meeting: January 21, 2023
May 3-6, 2023; Rotterdam, Netherlands
June 3-7, 2023, San Diego, CA