• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar

SATA

Society for the Advancement of Transplant Anesthesia

  • Home
    • For Authors
  • About SATA
    • Committees
      • Abdominal Educational Committee
      • Bylaws Committee
        • SATA Bylaws
      • Cardiothoracic Transplant Committee
        • Cardiothoracic Transplantation Educational Task Force
      • Critical Care Medicine Committee
      • Federation Working Group
      • Fellowship Committee
      • Finance Work Group
      • Membership Committee
      • Newsletter Committee
      • Pediatric Transplant Committee
      • Practice Management Working Group
      • Quality and Standards Committee
      • Research Committee
      • TEE Working Group
      • Vanguard Committee
      • Website Working Group
  • Membership
    • Join Now
    • Gift Memberships
  • fSATA
  • Education
    • Upcoming Events
    • Meetings
    • Education Materials
      • Article of the Month
      • Protocols / Recommendations / PBLDs
      • Educational Media
      • Transplant Fellowship Information
      • Archive
  • Research
    • SATA Seed Project Funding
    • SATA Publications
  • Newsletter
  • Careers
    • Jobs
    • Post a Job
  • Contact
  • Log In

Sergio

Fall 2024 SATA Newletter

November 14, 2024 By Sergio

 

UNOS News

By Flora Simmons, MD

White Paper Analyzes the Ethical Issues in Normothermic Regional Perfusion

The OPTN board has approved release of a white paper addressing the ethical principles involved in normothermic regional perfusion (NRP), an approach to help facilitate improved organ function after cessation of circulation in donation after circulatory death cases. Ethical concerns have been raised given the involvement of recirculation after declaration of death. This white paper reviews the ethical implications of NRP according to established ethical principles guiding donation and transplantation. Link here

 


SATA Member Corner: 5 minutes with Dr. Ryan Nazemian from Lahey Hospital and Medical Center

By Alex Ruan, MD

Can you share a little bit about your background and your journey to a career in medicine? 

I grew up and went to medical school in Yazd, Iran. Right after medical school, I moved to the United States and found a research position in Cleveland, Ohio, and did my PhD at Case Western Reserve University. My PhD research mentor, James Reynolds, was doing basic science and pharmacology research in anesthesiology. We were working on organ donors and nitric oxide bioactivity. I got introduced to anesthesiology through him, and then I worked with a couple anesthesiologists there. After finishing my PhD, I matched at the anesthesiology program at Case Western Reserve University. 

 

Why transplant anesthesiology?

During residency, I liked the transplant cases. I really like big complex cases. And that made me look into liver transplant fellowship programs and found Lahey here in Burlington, Massachusetts.  I came here for fellowship and stayed on ever since.

I really like the complexity of the cases, and the fact that we are very involved with the patient care perioperatively. I think liver transplant is one of the most beautiful procedures that we can do – every case is different and has its own challenges, and once the liver starts working, the patient becomes a completely different person. And of course, given my research background, I really like the research part of it. I think there’s still many, many things that we don’t know about transplant anesthesia and transplant in general. So I think it’s actually a very young field, and there are a lot of opportunities here.

 

Why did you join SATA? How long have you been a member of SATA and what is your current involvement with the organization?

I found SATA one day during an online search as I was just starting to look into transplant anesthesiology. I found Lahey Clinic through the SATA fellowship database, actually. I’ve really enjoyed being involved with SATA, through it I’ve made a lot of friends, you, Dieter Adelmann, Michael Bokoch, and others that I enjoy collaborating with. I also enjoy going to the meetings – all our meetings are extremely educational and it’s a great opportunity to regularly connect with people. I’m currently part of the Vanguard Committee and lead the Social Media Subcommittee efforts. 

 

What are your research interests, and do you currently have any research/ clinical projects going on?

My research interest has always been the field of transplantation in general. I started with organ donors, but now my research is on outcomes, such as fast-track and ERAS protocols. I am working on the early extubation project that several centers are involved through the SATA database. I also have a project looking at the use of methadone and ketamine for pain management in liver transplantation, which we just presented at ILTS.

 

What is your favorite piece of anesthesia equipment? 

I really like 14g IVs and MAC lines. IVs are such a simple but effective anesthesia instrument. It definitely has saved me many times in the operating room. It’s quite cheap, and so effective. Also, the MAC line – I use it in all my liver transplant cases, It’s relatively easy to place, and overall can be used for many things such as massive blood transfusion

 

What do you enjoy doing outside of work? 

I really enjoy spending time with my family. I have a 2-year-old son, and we are expecting another baby soon. I also love watching movies and sports on TV. I’m a huge fan of FC Barcelona and I watch all their games. I’m hoping that once my son is older, we can go to Barcelona and watch some games together. 

 

What advice would you give to a medical student or resident who is interested in liver transplant? 

I encourage everyone to have an open mind on their transplant rotation – some medical students and residents get intimidated by liver transplant because some of these patients are quite sick. I remember I had a resident once and they had a quite challenging month. But then, at the end of the month. I took them to the post-op floor, and we saw some of those patients walking and talking and laughing, which was really amazing.

 

Dr. Nazemian can be reached at ryan.nazemian@lahey.org or via the SATA Instagram via @transplant.anesthesia

 

If you or someone you know is interested in being featured in the SATA newsletter, please reach out to Dr. Alexandra Ruan aruan@stanford.edu


In the Spotlight: University of Michigan Medical Center

By David Rosenfeld, MD, FASA 

 

We would like to thank Dr Sathish Kumar, Section Head and Medical Director of Transplant Anesthesiology for University of Michigan, for providing us with the highlights of their well-established program.  

Transplant services offered at U of M include adult and pediatric deceased donor and living donor liver transplants, combined liver-kidney and heart-kidney transplants, and a heart-liver transplant program is in the planning stages.  Dr. Seth Wait is the Director of liver transplant surgery program.

The adult liver team consists of ten dedicated anesthesia faculty members and a consistent and strong liver anesthesiology fellowship program led by Dr. Sean Ewing.  The fellowship has seen an increasing number of external and internal interested candidates, currently with two fellows, including one pursuing a T-32 research track over a two-year period.

 The University of Michigan Liver Transplant Program is at the forefront of research and innovation including being the home to multicenter perioperative outcome research and driving clinical trials and studies in liver and kidney transplantation.  Currently over 90% of cases utilize normothermic perfusion devices, significantly increasing transplant volumes.  Other innovative initiatives include the Rapid Review and Sub-MELD15 Club, Led by Dr. Waits.  This initiative helps risk-stratify and accept expedited offers for suitable candidates.  They have a unique and focused Liver Transplant Perioperative Cardiac Risk Committee, which is multidisciplinary including anesthesiology, hepatology, transplant surgery, and cardiology experts working to mitigate cardiovascular risks in high-risk transplant recipients.  In this group exists a Dedicated Transplant Cardiologist, Dr. Nicole Bhave, who quarterbacks risk stratification for solid organ transplant recipients.

Looking ahead, as the program continues to grow, the University of Michigan Liver Transplant Program is on track to perform its highest transplant volume in program history.  They remain committed to providing exceptional care, advancing research, and training the next generation of transplant specialists with a commitment to excellence in patient care, research, and education driving success.  Clearly it’s not all football in Ann Arbor and hats off to the great team at Michigan!

Many thanks to Dr. Kumar for sharing details of their program.  If interested in having your program highlighted in the future, please contact David Rosenfeld, Mayo Clinic Arizona at Rosenfeld.david@mayo.edu


The Research Corner

By Michael Trostler, MD

 

Current indications and selection criteria for early liver transplantation in severe alcohol-associated hepatitis. By Ramirez-Cadiz Et Al.

This narrative review of the natural history of alcoholic hepatitis (AH) finds that mortality for alcoholic cirrhosis was decreased with earlier liver transplant.  Early transplant without a 6 month period of abstinence from alcohol should be considered as patients with AH may not survive their initial illness, and if they do survive often don’t recover liver function.

 

Effect of Dexmedetomidine on the Incidence of Postoperative Acute Kidney Injury in Living Donor Liver Transplantation Recipients: A Randomized Controlled Trial by Kwon et al.

Double Blinded RCT performed in South Korea of 205 patients examining the effects of dexmedetomidine (PrecedexⒸ) on the effect of AKI on patients receiving living donor liver transplantation (LDLT).  Results were encouraging with 35% of the study group having AKI and 50% of the control group.  Lactate levels were also significantly lower in the study group.  The potential to reduce ischemia-reperfusion injury during liver transplant hold great clinical importance to morbidity and mortality, this may be one component moving forward to alleviate some of the burden.

 

Universal intraoperative systemic heparin administration during liver transplantation: A case series By Diaz et al. 

This retrospective review at University of Michigan evaluates a change in practice of giving IV heparin prior to portal venous cross-clamp to only selected patients vs all patients. The study only had an incidence of intracardiac thrombus of 1.6%, it may be as high as 5-10%.  While the study did not have the power to see a statistical decrease in thrombotic events they did find that total blood product usage did not increase with increasing doses of heparin, and that there wasn’t a higher incidence of bleeding complications.  This study suggests that routine use of intraoperative heparin is safe, but notes that further research is needed to find the optimal dose.

 


Special Topics
By Alex Stoker, MD

Imaging piggyback outflow anastomosis with TEE during orthotopic liver transplantation

Sufficient venous outflow from a transplanted liver is necessary to ensure optimized perfusion pressure and for long term allograft survival. Stenotic piggyback anastomosis results in poor venous outflow and can lead to not only hemodynamic instability due to decreased right ventricular preload but also poor allograft function due to venous congestion. Transesophageal echocardiography (TEE) may be used to visualize the liver outflow anastomosis. Typically, the piggyback anastomosis can be imaged by advancing the TEE probe from the midesophageal bicaval view to image the IVC at the level of hepatic veins. Increasing the omniplane angle anywhere from 30-90 degrees may be necessary to fully visualize the piggyback anastomosis (see figure below). In the case of piggyback anastomosis stenosis, color flow Doppler will reveal flow acceleration with a high velocity and turbulent jet originating at the level of stenosis. It is important to recognize that some flow acceleration may be seen across the anastomosis in the absence of clinically significant stenosis due to a high cardiac output state and hyperdynamic circulation. There is increasing use of TEE to evaluate hepatic and IVC vasculature during liver transplantation and should be considered when venous outflow concern arises (Khurmi et al, 2019).

Reference:
https://pubmed.ncbi.nlm.nih.gov/31321114/

Figure. TEE image with and without color flow Doppler, demonstrating a widely patent piggyback anastomosis after reperfusion of the liver allograft. TEE view obtained by advancing the probe from midesophageal bicaval view to the level of hepatic veins. IVC, inferior vena cava. 

 


SATA Committee and Leadership Updates

The SATA Fellowship Committee – under the leadership of Dr. Ramona Nicolau-Raducu, has been actively involved in various educational initiatives, including a well-received fellow lecture series. Current projects include collaboration with the International Liver Transplant Society on developing guidelines for liver transplant anesthesia fellowships and cultivating networking opportunities for fellows, including planning social events at upcoming liver transplant anesthesia meetings. Our committee contributes to a comprehensive list of liver transplant anesthesia fellows and their directors, and we are committed to enhancing educational programs for fellows. We also continue to work with the Vanguard Committee to connect fellows with speaking opportunities and involve fellows in research presentations at SATA regional meetings. By Christine Nguyen-Buckley, MD

The SATA Membership Committee – was initially responsible for establishing the SATA membership list and membership communications. After this foundational work, we have been able to grow SATA with the expert support of PACA, our management company. While PACA now handles day-to-day membership operations, the SATA Membership Committee remains dedicated to addressing any member concerns. We are committed to both recruiting new members and retaining our valued current members. Our past initiatives have been aimed at enhancing the value of SATA membership. We also continue to partner closely with other committees such as the Vanguard and Fellowship committees. We invite you to share your thoughts on how we can further enhance the SATA membership experience by reaching out to us at sata@pacainc.com.  By Christine Nguyen-Buckley, MD

 

Abdominal Transplant Committee – for SATA has been quite busy over the past 3 years. We are excited to share that we have published two white papers in Clinical Transplantation. “Regional Anesthesia for Transplantation Surgery – A White Paper Part 1: Thoracic Transplantation Surgery” was published in June 2023. The subsequent installment entitled, “Regional Anesthesia for Transplantation Surgery – A White Paper Part 2: Abdominal Transplantation Surgery” was published in January 2024.

Since this recent success, the members of the ATC have started work on two new projects. We are currently in the literature review stage for a planned review paper covering machine perfusion in liver transplantation surgeries. The group is also in the beginning stages of a survey-based project that will poll anesthesia liver transplant directors regarding the use of regional anesthesia in the perioperative setting of liver transplantation surgeries.

The ATC hopes to attract additional SATA members who provide care for abdominal transplantation patients at their home institutions. We are looking for members who have an interest in research as well as further refining anesthesia care in the field of abdominal transplantation surgeries. If interested in joining SATA’s Abdominal Transplant Committee, please reach out to any ATC members. By Michael Ander, MD


SATA Seed Grant Application

We invite you to submit your application for the 2025 Seed Grant! The SATA Seed Grant is a one-year, $5,000 starter grant for transplant projects, open to junior faculty members and trainee physicians (residents and fellows). This grant aims to inspire and assist aspiring faculty/trainee physicians in initiating a transplant-related research project. It is specifically intended for projects that have not previously received extramural / non-departmental funding. Recipients must have sufficient departmental support to complete the project within one year. 

 

Application/Grant Cycle Timeline

October 11, 2024 Announcement of the grant
November 4  – December 2, 2024 Proposal Submission (Phase 1)
December 18, 2024 Invitations to submit full proposals will be sent out
January 20, 2025 Submission deadline for full proposals (Phase 2)
February 19, 2025 Announcement of the awardee and send letters of feedback to the other applicants 
March 23, 2025 Project presentation at SATA National Meeting in Honolulu, HI
July 1, 2025 Grant initiation
December 2025 Submission of the mid-term report
August 2026 Submission of the final report

 

Eligibility Requirements
Applicants must: 

  • Be a current member of the SATA.
  • Have received no prior extramural (“outside”) research funding for this specific project.
  • Be a trainee (resident/fellow) with dedicated research time or faculty within ten years of their first appointment.
  • Present an original project idea.
  • Name a mentor and submit a mentoring plan (only required for Trainees and Faculty within three years of their initial appointment)
  • Have the full support of the Department Chair, who must sign off on the grant application if awarded.
  • Have the full support of the Program Director if the applicant is a trainee. 
  • Submit a budget plan. This grant does not cover overhead or salaries, as it is a starter grant. While the SATA Seed Grant cannot be applied to salary support, it can be used to support costs for professional services from salaried professionals that are essential for the planning or execution of the project (e.g., statistician fees).
  • Agree to present the completed study (or a progress report) at the SATA National Meeting following the award, including a financial report detailing how the grant was used.
  • When submitting a manuscript to a peer-reviewed journal for publication, the investigators must acknowledge SATA Seed Grant funding.

 
Application requirements, instructions, and process. 

The grant application must include the following and must be submitted to sata@pacainc.com:

 

Phase 1: 

  • Letter of Intent 

To include:

  1. Project Title 
  2. Name of the Investigator & Mentor
  3. Description of the Proposed Research (500-word limit).
    Structure:

    • Background & Significance (2 paragraphs)
    • Specific Aim (1 paragraph)
    • Methods (1-2 paragraphs)
  • Applicant Biosketch
    • (NIH Biosketch), including a personal statement tailored to this application.

 

Phase 2: 

The SATA Research Committee will select three submissions and invite the three applicants to submit a complete application & a 5-minute recorded presentation of their planned research.

 

Additional Documents for Phase 2:

  1. Detailed project plan
    To include Objective, Background, Hypothesis, Aims, Methods and Materials, Timeline, Pitfalls, Solutions, Significance, and References. (2 pages + references)
  2. Mentor Biosketch
    (A mentor is required if the PI is a trainee or a junior faculty member – within three years of their initial appointment)
  3. Budget and Budget Justification
    Please note: the grant does not cover overhead or investigator salaries. (1 page)
  4. Mentoring plan
    A mentoring plan, written by the mentor, is required if the PI is a trainee or a junior faculty member – within three years of their initial appointment (1 page)
  5. Letter of support and commitment
    From the Mentor (if the PI is a trainee or a junior faculty member – within three years of their faculty appointment) or the Department Chair (for faculty members starting in the 4th year of their appointment) (1 page)

 

Selection Process

The review process will consist of two phases: The SATA Research Committee & SATA Council will review all letters of intent (Phase 1). Three investigators will be invited to submit a full proposal (Phase 2). One grant will be awarded per year.

 

Reporting and Award Requirements

Awardees must submit two progress reports six months and one year after the receipt of the grant:

The 6-month report should be brief (less than two pages) and include:

  • Progress made to date (including expenses).
  • Difficulties encountered or anticipated roadblocks and plans to mitigate them.
  • Identification and explanation of any changes made from the original proposal.
  • The committee will review the progress report and help resolve problems that arise to ensure the success of the grant recipient.

 
The 1-year report must be provided for review 13 months after the beginning of the Grant Period. The report will include:

  • A summary of the objective and the results of the study,
  • Any changes in the research project or mentorship,
  • Publication or abstracts that have been generated from the study,
  • A financial report detailing how the grant money was spent,
  • Award of further funding.

 

The grant will be awarded to the grant recipient’s institution. All expenses funded by the grant are to be paid by the institution. Any unused funds are to be returned to SATA. The SATA and its auditors reserve the right to receive documentation and itemized expense receipts upon request.

 

Please address your questions regarding the application process to Dr. Dieter Adelmann (Chair of the SATA Research Committee) at dieter.adelmann@ucsf.edu.

For administrative questions, please reach out to the SATA Office at sata@pacainc.com.

 


Upcoming Events and Meetings

SATA Meetings:

SATA Southeastern Meeting, Virtual

Saturday November 16, 2024

 

SATA West Annual Meeting, San Francisco, CA 

Saturday December 14th, 2024

 

The 2025 Symposium for the Society for the Advancement of Transplant Anesthesia 

SATA Annual Meeting, Honolulu, HI

Monday March 23, 2024

(In conjunction with the IARS Annual Meeting)

More information coming soon!

 

Other Meetings:

KoreAnesthesia, Korean Society of Anesthesiologists Annual Meeting

November 7-9, 2024, Incheon, Korea

 

The Liver Meeting, The American Association for the Study of Liver Disease (AASLD)

San Diego, CA, November 15, 2024

 

The International Society for Heart and Lung Transplantation (ISHLT) Annual Meeting

Boston, MA, April 27-30

 

UNOS Transplant Management Forum

San Antonia, TX, May 5-7, 2025

 

The International Liver Transplant Society (ILTS) Annual Congress

Singapore, May 28-31, 2025


SATA BOARD OF DIRECTORS: TERM  2023 – 2024

President
Gebhard Wagener, MD

Immediate Past President
Tetsuro Sakai, MD, PhD, MHA, FASA

Founding President
Ernesto A. Pretto Jr., MD, MPH

President-elect
Lorenzo De Marchi, MD

Secretary
Jiapeng Huang, MD, PhD, FASA, FASE 

Treasurer
Ranjit Deshpande, MBBS 

Executive Council

Michael Ander, MD, FASA

Adrian Hendrickse, BM, MMEd, MAcadMEd, FRCA

Sathish S. Kumar, MD

Raymond M. Planinsic, MD, FASA

Newsletter Editor-in-Chief
David Rosenfeld, MD, FASA

Newsletter Editorial Board

Sennaraj Balasubramanian, MD

Amit Bardia, MD

Andrew Gorlin, MD

Jiapeng Huang, MD, PhD, FASA, FASE

  1. Susan Mandell, MD, PhD

Sergio Navarrete, DO

Yong G Peng MD, PhD

Alexandra Ruan, MD

Flora Simmons, MD

Natalie Smith, MD

Alex Stoker, MD

Michael Trostler MS, MD

 

Filed Under: Newsletter

SATA Seed Funding

December 29, 2023 By Sergio

SATA has established a Seed Grant funding mechanism!

SATA Seed Project Funding

Filed Under: Announcements

ILTS & SATA Perioperative Care in Liver Transplantation Meeting 2023

July 7, 2023 By Sergio

Dear SATA Members, Residents and Fellows,

The International Liver Transplantation Society (ILTS) and the Society for the Advancement of Transplant Anesthesia (SATA) are pleased to announce the first joint Perioperative Care in Liver Transplantation Meeting, which will take place on Friday, October 13, 2023, in San Francisco.

The program will feature multidisciplinary panels discussing the perioperative management of liver transplant patients, PRO/CON debates, and presentations of challenging cases.

We warmly invite you to join us in San Francisco for this event.

Dmitri Bezinover (ILTS), Gebhard Wagener (SATA)

Event Date

October 13, 2023 8:00 am – 5:00 pm

Event Location

UCSF Mission Bay Conference Center

San Francisco, California

 

Directions

Click here for directions from San Francisco International Airport to UCSF Mission Bay Conference Center. 

 

Program Agenda

Click here to review the Program Agenda

 

Registration

Click here to register 

Filed Under: Announcements, Meeting

Spring 2023 SATA Newsletter

June 27, 2023 By Sergio

SATA Annual Meeting, Denver Colorado – Recap

By Natalie Smith, MD

 

The Annual SATA Meeting was held in conjunction with the International Annual Research Society (IARS) meeting in the mile high city of Denver 2023 on April 17. Members welcomed back the in-person gathering as a chance to mingle with their colleagues.  The meeting content fostered  lively discussions, new ideas, and  collaborations. Expert speakers from anesthesiology, surgery, and hepatology covered topics in the fields of abdominal and thoracic transplantation.  Coagulation, pain and analgesia, organ donation and allocation, and perfusion management with angiotensin II and terlipressin were hot topics on the agenda.

Two lectures were given by members of the government organization, the Organ Procurement and Transplant Network on the future of transplantation in the US. 

Drs. Lorenzo Dimarchi, SATA Secretary  Gebhard Wagener, SATA President Elect, and Tetsuro Sakai, SATA President, addressed the audience on the State of the Society covering current and future activities.  We look forward to seeing you at next year’s meeting.

UNOS News:

Flora Simmons, MD

 

Improvements to MELD and PELD

UNOS will soon be rolling out MELD 3.0 and PELD creatinine and to support this rollout, new and updated fields will be available.

  • The data input for all transplant candidates will now include “birth sex” instead of “gender”.

  • A new field, “Sex for Purposes of Adult MELD Calculation” will be included for all adult liver candidates.

  • MELD 3.0 will include albumin.

  • PELD will include creatinine.

The OPTN has scheduled webinars to help transplant programs prepare for the upcoming changes. Please see the link above.

 

Living Donor Protection Act

UNOS continues to support legislation to reduce barriers to living donation. The Living Donor Protection Act is a bipartisan bill that protects living organ donors from discriminatory barriers such as higher life and disability insurance premiums and denial of coverage based on living donor status.

 

New Lung Allocation Policy In Effect

The OPTN has launched a new policy for matching lung transplant candidates with organs using a process known as continuous distribution. A weighted score is calculated for each lung transplant candidate and each lung offer from a donor. This system should increase equity and access to transplant.

 

UNOS Celebrates 25,000 Kidney Transplants Performed In 2022

Thanks to increased donations and innovative organ utilization strategies, there is a new record for kidney transplants. More than 25,000 kidney transplants were performed in 2022. 

 

 

Research Updates and Interesting Articles

Michael Trostler, MD

Liver Transplantation in the Management of Cholangiocarcinoma: Evolution and Contemporary Advances

Cholangiocarcinoma is a rare malignancy of the biliary tract <6 per 100K, with unresectable lesions having a median survival of 6-12 months.  While many cases remain unresectable, liver transplantation is a viable method of removing the entire lesion.  These patients are not able to be listed for transplantation through the normal means due to historically poor outcomes and recurrence, but living donor transplantation through directed donation is an accepted practice.  Perihilar cholangiocarcinoma was associated with 51.7% survival at 5 years with neoadjuvant chemotherapy and recurrence rates of 24.1%.

Data suggests liver transplantation has a better survival than intent to curative resection.  Further improvements in chemotherapeutic and biological agents may further improve the outcomes and make liver transplant more mainstream for cholangiocarcinoma 

Liver Transplantation for the Nonhepatologist

Review of liver transplant indications and complications for those who may have to take care of liver transplant patients before or after transplant.

 

Enhanced recovery for liver transplantation: recommendations from the 2022 International Liver Transplantation Society consensus conference

International Liver Transplantation Society (ITLS) consensus recommendations of enhanced recovery for liver transplant with grades of recommendation and quality of evidence for preoperative, intraoperative, and postoperative measures for both living and cadaveric recipients and for living donors.

 

Special Topics/New Publication
Alex Stoker, MD and Michael Trostler

Intracardiac Thrombosis and Pulmonary Thromboembolism During Liver Transplantation: A Systematic Review and Meta-Analysis

Intracardiac thrombus (ICT) during orthotopic liver transplantation is a rare but potentially catastrophic event, with retrospective studies describing an incidence of 0.4% to 4.2% and a mortality of 40% to 45.5% (P Peiris, MK Groose). ICT is typically diagnosed by TEE (see image below) and has been most often identified around the time of reperfusion in the neo-hepatic phase.  Although the pathophysiology of ICT formation during liver transplantation is not completely understood, retrospective studies have described several risk factors for ICT including higher MELD score, preexisting venous thrombosis, atrial fibrillation, higher BMI of donor, prior TIPS procedure, and longer warm ischemic times. Intravenous heparin administration has been associated with lower incidence of ICT formation when administered prior to IVC clamping and may prevent early-stage thrombus from further progression. Most common during reperfusion and the neo-hepatic phase, typical treatment regimens include heparin or tPA.  Treatment from previous articles on the subject recommend heparin to prevent propagation of the clot and in this new meta-analysis, Kumar and colleagues found 76% of patients had prevention of thrombus progression and restoration of hemodynamics.  Addition of tPA offered diminishing returns, but should still be considered for flow limiting thromboemboli or hemodynamic compromise (N Kumar).

Midesophageal 4 chamber view in systole showing an intracardiac thrombus in the right atrium, an enlarged and dysfunctional right ventricle and an interatrial septum bowing leftward, likely due to additional pulmonary thromboembolism.

 

Organ Donation Updates

By Alexandra Ruan, MD

 

HRSA Announces Organ Procurement and Transplantation Network Modernization Initiative

The Health Resources and Services Administration (HRSA) announced a new modernization initiative to strengthen accountability and transparency in the organ donation system. Proposed changes include:

·  Increasing the Fiscal year 2024 budget to $67 million, nearly double from previous years;

·  Data dashboards with individual transplant center and organ procurement organization data;

·  Modernization of the OPTN IT system;

·  Create an independent OPTN board of directors;

·  Increase the pool of eligible contract entities to enhance performance and innovation through increased competition

 

Bridge to HOPE Trial Closes Early

Bridge to Life, Ltd. announced in May 2023 that the results from interim analysis resulted in early enrollment closure of its multicenter, randomized, controlled clinical trial of its hypothermic oxygenated perfusion (HOPE) system. Early results suggest that HOPE is statistically superior to static cold storage (SCS) for the primary trial endpoint of early allograft dysfunction.

 

In the Spotlight:  The Mayo Clinic Enterprise Abdominal Organ Transplant 

David Rosenfeld, MD, FASA

 

The Mayo Clinic was officially founded in Rochester, MN, in the late 1800s under the leadership of surgeons Will and Charles Mayo. The entire Mayo system currently encompasses over 76,000 employees divided between the three destination sites in Rochester, Jacksonville (founded 1986), and Phoenix/Scottsdale (founded 1987), and twenty smaller regional centers in the midwest.  Mayo was an early pioneer in transplantation with their first kidney in 1963 and currently are one of the largest abdominal transplant networks in the world with 1,035 kidneys, 525 livers, and 52 pancreases transplanted in 2022 between the three destination sites in Minnesota, Florida, and Arizona.  Each of these centers function independently within their regions, however there is significant collaboration between the surgical and anesthesiology departments clinically, and academically.  There exists an internal Mayo live donor kidney exchange program, and  three site Mayo Clinic group has joined the SATA Transplant Database Project in 2022.   

Alexandra Anderson, MD, is Section Head of Solid Organ Transplant Anesthesiology at the largest Rochester campus which performed 311 kidney transplants, 130 livers, and 9 pancreas transplants in 2022. Their living donor liver transplant program has grown, and the anesthesia team has developed specific multimodal protocols for donor analgesia. The kidney transplant team performs simultaneous bilateral nephrectomy and kidney transplantation for polycystic kidney disease. Ongoing anesthesia research efforts are underway focusing on cardiac assessment in liver transplant patients and analgesia in kidney transplant patients. Quality improvement practices have resulted in TEE education for attendings, emergency ECMO activation workflow pathways, and standardized protocols for venovenous bypass in cases where this is used.   

Stephen Aniskevich III, MD, is Chair, Division of Hepatobiliary and Abdominal Transplant Anesthesia in Florida. Their abdominal transplant team consists of 9 attendings who cover all liver, kidney, and pancreas transplants.  The Florida campus performed 144 livers, 225 kidneys, and 12 pancreas transplants in 2022 and is the #1 ranked program with regards to liver transplant outcomes in the US.  Mayo Florida is also one of the few centers worldwide performing fast track anesthesia for liver transplantation with 60% of patients bypassing the ICU, with admission directly to the ward following their transplant.  The anesthesia team also actively participates in their complex high-risk liver selection committee. This multispecialty group evaluates patients who would have historically been denied liver transplant and devises novel, individualized treatment strategies to allow for surgery such as pre-emptive ECMO for pulmonary hypertension and a variety of strategies for management of complex cardiac conditions during transplant. The surgical team utilizes a wide array of organ preservation strategies including NRP, NMP (OCS and Organox) and is participating in studies using hypothermic oxygenated machine perfusion. 

Peter Frasco, MD, is Section Head, Abdominal Organ Transplant Anesthesiology at the Arizona campus which includes 8 highly dedicated attendings.  The Arizona campus was the busiest abdominal transplant center in the US in 2022 with 499 kidneys, 245 livers, and 29 pancreases performed with 9 surgeons.  They also performed their first combined cardiac/liver/kidney transplant in 2023.  The liver transplant team at Mayo Arizona initiated a normothermic machine perfusion protocol utilizing the OCS™ device (TransMedics, Inc.) in late 2021.  To date NMP has been used in over 160 liver transplants.  In addition to the well-described intraoperative benefits of reduced occurrence and severity of reperfusion syndrome, and decreased blood product utilization, preliminary data shows that none of the 145 patients who have received a DCD allograft maintained with the OCS™ device have developed ischemic cholangiopathy.

Many thanks to the Mayo Clinic Enterprise teams for sharing these wonderful details.  If interested in having your program highlighted in the future, please contact David Rosenfeld at Rosenfeld.david@mayo.edu

 

Announcements

SATA Seed Grant Award Winner

The SATA Research Committee was pleased to present the first $5000 SATA Seed Grant to Dr. Elizabeth Townsend of University of Wisconsin to support her research on Kupffer cell inflammatory processes leading to fibrosis and end stage liver disease.

Dr. Townsend’s work on the P2X7 receptor on Kupffer cells that activates inflammatory eicosanoids as a cause of asthma recently earned a FAER grant.  Now she is turning her attention to inflammation and fibrotic remodeling in liver disease. The SATA starter grant is open to early career society members and trainee physicians to support aspiring researchers as they apply to other agencies in funding for transplant projects. Congratulations to Dr. Townsend

Dr. Tetsuro Sakai (left) with the SATA Seed Grant Winner, Dr. Elizabeth Townsend (center), and Dr. Dieter Adelmann (right)

Announcement

SATA has just closed the open nomination process for the next Councilors at Large and Treasurer.  Thank you to all of our members who applied and those who nominated others.  The final candidates will enter an open election where the membership will decide their next representatives.  Please look for the upcoming voting announcements.   

 

Announcement

SATA will now be at the ASA.  SATA and the ILTS have joined forces to provide all anesthesiologists interested in transplantation an opportunity to participate in a one-day meeting on the Friday immediately before the start of the ASA in San Francisco. 

Vanguard Committee Recruiting New Members

The Vanguard Committee hosted a SATA Sponsored networking event immediately after the Annual Meeting in Denver, CO. The event was an opportunity for junior SATA members to network and discuss ideas for future SATA projects. If you are interested in joining the Vanguard Committee please fill out this survey
 

Transplant Anesthesia Upcoming Meetings

SATA Meetings:

ILTS & SATA Perioperative Care in Liver Transplantation Meeting 2023
October 13, 2023, 8am-5pm. UCSF Mission Bay Conference Center, San Francisco CA

 

Other Meetings: 
41st Annual Scientific meeting (ASM) of the Transplantation Society of Australia and New Zealand (TSANZ)  June 17-20, 2023,  Brisbane, Australia   

18th Congress of the Intestinal Rehabiliation and Transplant Association (CIRTA 2023) 

June 30-July 3, 2023, Chicago, IL  

27th Annual Meeting of the Society of Pediatric Liver Transplant (SPLIT 2023)  October 16-17, 2023, Montreal, QC    

16th Organ Donation Congress (ISODP 2023)  October 18-21, 2023 Las Vegas, NV  

 
Are you enjoying the SATA Newsletter? Please fill out a quick survey!
 

BOARD OF DIRECTORS: TERM  2022 – 2023

President
Tetsuro Sakai, MD, PhD, MHA, FASA

Immediate Past President
M. Susan Mandell, MD, PhD

Founding President
Ernesto A. Pretto Jr., MD, MPH 

President-elect
Gebhard Wagener, MD

Secretary
Lorenzo De Marchi, MD

Treasurer
Jiapeng Huang, MD, PhD, FASA, FASE

Executive Council
Ranjit Deshpande MBBS
Adrian Hendrickse, BM, PgDipMEd, MAcadMEd, FRCA
Christine Nguyen-Buckley, MD
Ramona Nicolau-Raducu, MD, PhD
 


Newsletter Editor-in-Chief
David Rosenfeld, MD

Newsletter Editorial Board

Sennaraj Balasubramanian, MD
Amit Bardia, MD
Jiapeng Huang, MD, PhD, FASA, FASE
M. Susan Mandell, MD, PhD
Sergio Navarrete, DO
Yong G Peng MD, PhD
Alexandra Ruan, MD
Flora Simmons, MD
Natalie Smith, MD
Alex Stoker, MD
Michael Trostler MS, MD

Filed Under: Announcements, Newsletter

Winter 2023 SATA Newsletter

March 13, 2023 By Sergio

UNOS News

By Flora Simmons, MD

UNOS Launches National Liver Pairing Program

In an effort to increase access to living donations, UNOS has initiated a national pairing program for swapping livers.  While some transplant centers have swapped livers within their own hospitals, this program now allows swapping across the nation.  

Waiting Time Adjustment Approved For Kidney Transplant Candidates Affected By Race-based Calculation

After discontinuing race-based calculations for estimated glomerular filtration rate (eGFR), the new policy will now allow African-American kidney transplant candidates to receive waiting time modifications that will increase their waiting times and associated prioritization for transplant. 

National Collaboration To Increase DCD Lung Transplantation Underway

UNOS recently launched a national initiative to identify and share effective practices that can increase transplantation of DCD lungs. Twenty-nine lung transplant programs are participating in this project. 

 

Research Updates and Interesting Articles

By Michael Trostler, MD

  • Validation of the Liver Transplant Risk Score in Europe

LTRS is a useful predictor of Mortality that has been validated in the United States, but not in Europe.  Based on the data the European registry collects, the score has been modified to exclude Diabetes.  Age, BMI, MELD score, and Dialysis status were used with linear correlation for 90-day and 1-year mortality for each point.  Included 2nd article external validation of LTRS in US (2020).

Validation of the Liver Transplant Risk Score in Europe.pdf

Preoperative Stratification of Liver Transplant Recipients- Validation of LTRS.pdf

 

  • Anesthesia Management of a Liver Transplant Recipient with Remimazolam

Case report of a 54 year old Female who had a prolonged living donor liver transplant (1037 min) and massive blood loss (22.5L) who was successfully managed with Remimazolam without recall or adverse events with EEG monitoring.

Anesthesia Management of a Liver Transplant Recipient with Remimazolam.pdf

 

  • Survival Benefit of Living-Donor Liver Transplant

Large epidemiological study on 119,275 Liver transplant patients, with 2,820 living donor transplants which found a 13-17 year life gain for those who received a liver donor transplant for MELD>11, compared to those who stayed on the waiting list.  This article generated significant interest with several comments/letters and the original authors reply which are well worth your time to read.

Survival Benefit of Living Donor Liver Transplant.pdf

Reply to Survival Benefit of Living Donor Liver Transplant 1.pdf

Reply to Survival Benefit of Living Donor Liver Transplant 2.pdf

Reply to Survival Benefit of Living Donor Liver Transplant 3.pdf.

  • Mortality scoring systems for liver transplant recipients: before and after model for end-stage liver disease score

An updated review article of end stage liver disease scoring systems and their inherent weaknesses.  The future may be artificial intelligence, but its predictive algorithms can be individualized and may not be applicable to the wider population outside of each study cohort.

Mortality scoring systems for liver transplant recipients- before and after model for end stage liver disease score.pdf

  • Comprehensive quality initiative leads to immediate postoperative extubation following liver transplant

A concerted push via QA/QI project achieves safety and success for immediate extubation of liver transplant recipients in both low risk and high risk patients.  There was no change in mortality and only four(1.26%) patients were reintubated within 24 hours (Total 317 patients).  Quality initiative pushes immediate extubations from 13.4% to 86.7% over a five year period. 

Comprehensive Quality initiative leads to immediate postoperative extubation following liver transplant.pdf

 

Special Topics

By Alex Stoker, MD

IVC stenosis during liver transplant detected with TEE

Acute inferior vena cava (IVC) stenosis after liver transplantation is a rare but significant complication that can result in liver allograft congestion and dysfunction as well as hemodynamic instability. Transesophageal echocardiography (TEE) may be used to diagnose IVC stenosis, which may reveal a high velocity or turbulent jet entering the right atrium from the IVC as detected with color flow Doppler (CFD) (see figure below). By interrogating the IVC, it may be possible to visualize the area of narrowing within the IVC, with CFD revealing flow acceleration and turbulent flow originating at the level of stenosis. Obstruction may occur in the suprahepatic IVC, infrahepatic IVC or hepatic veins and can be due to surgical complication or due to thrombosis. There is increasing use of TEE to evaluate hepatic and IVC vasculature during liver transplantation (Khurmi et al, 2019). Reference

Midesophageal bicaval view with color compare showing the image both with and without color flow Doppler. A turbulent and high velocity jet is seen entering the right atrium from the IVC due to IVC stenosis. LA, left atrium; RA, right atrium; IVC, inferior vena cava; SVC, superior vena cava.

2022 UNOS Organ Transplant Summary

By Alexandra Ruan, MD

https://unos.org/news/2022-organ-transplants-again-set-annual-records/

 

  • More than 42,800 organ transplants performed in 2022, a 3.7% increase from 2021
  • Total kidney transplants exceeded 25,000 for the first year ever
  • Annual records also set for liver (9,528), heart (4,111) and lung (2,692) transplants
  • Over 6,400 living donor transplants
  • Deceased donation increased for 12th consecutive year
  • The U.S. has now performed over 1 million transplants

 

In the Spotlight:  Virginia Commonwealth University (VCU) Health System – Hume/Lee Transplant Center

By David Rosenfeld, MD, FASA

 

For this winter’s section we reached out to Spencer Liebman, MD, who is Chief, Division of Transplant Anesthesiology at VCU. Formerly known as Medical College of Virginia, VCU is an 820 bed health system and one of the nation’s first transplant programs.  This historic program is named for David M. Hume, MD and Hyung Mo Lee, MD, and is where one of the earliest identical twin kidney transplants was performed in 1957, with the overall program starting in 1962.  Soon after livers began in 1964, with the world’s 16th heart transplant in 1968.  The scope of organs includes livers, kidneys, pancreas, and hearts, with experience in combined heart-liver transplant.  A total of 502 organs were transplanted in 2022. 

VCU offers 112 ICU beds, 16 of which are cardiac, and a dedicated transplant ICU growing to 10 beds under the direction of Megan Rashid, MD.  The liver practice is large with 168 total adult organs, 21 of which were from living donors.  Staffing is in a team care model with five dedicated attendings, six specially trained CRNAs, and residents rotating in their CA2/CA3 years.  TEG is universal, and TEE is utilized for greater than 80% of cases.  As is becoming more common, intraoperative hemodialysis (not CRRT) was used in 40% of cases in 2022.  They offer a unique Active Severe Alcoholic Hepatitis Transplant Program with support services and strategies in place.  VCU has a non-ACGME liver fellowship with a hybrid model of combined fellow and faculty time and two positions per year.  In 2016 the Total Pancreatectomy with Islet Cell Autotransplant (TPIAT) program was started with the addition of Transplant Surgeon Marlon Levy, MD to the faculty.  A total of 18 TPIATs were performed in 2022 for chronic pancreatitis, and they are one of the few centers offering this experimental therapy.  Their cardiac program is the longest running on the east coast and the second oldest in the US.  Over 680 heart transplants have been performed, and they offer an ACGME accredited Adult Cardiothoracic Anesthesiology fellowship with two fellows per year.  There are no lung transplants being performed at present.

Many thanks to Dr. Liebman for sharing details of the transplantation program at VCU.  If interested in having your program highlighted in the future, please contact David Rosenfeld, Mayo Clinic Arizona at Rosenfeld.david@mayo.edu

*The original newsletter identified VCU as performing the first identical twin kidney transplant in 1957.  This was in error, the first kidney transplant was performed in an identical twin by Dr Joseph E.Murray in Boston in 1954.  Correction made above.   

Report from the Executive Council

By Susan Mandell, MD

We look forward to seeing SATA members at the in person SATA National Meeting, held at the IARS on April 17th, 2023, in Denver Colorado.  Please remember to renew your membership for free entry to the meeting.  SATA is pleased to announce it will hold the first combined meeting with the International Liver Transplant Society-SATA meeting  just prior to the ASA in San Francisco. This has been a very popular meeting and well attended. 

The Council is pleased to announce that there are now seven regional SATA meetings.  Please check for the meeting closest to you.  Service on the SATA Accessibility and Diversity Committee is now open to all members.  The Vanguard committee has been revitalized and membership is open to all faculty who are within 5 years of residency completion or are younger than 42, please reach out to the SATA Office for more information.   

Announcements

We are pleased to announce that SATA will be represented at the 10th Annual Korean Society of Transplant Anesthesiologists (KSTA) meeting in Seoul, Korea. During the Joint KSTA-SATA session (March 18, 2023 11:20-12:50 KST), moderated by Dr. Tetsuro Sakai and Justin Sangwook Ko, Dr. Satish Kumar will present on emerging evidence for coronary artery disease screening in liver transplant candidates and Dr. Ramona Nicolau-Raducu will present on post-reperfusion hyperfibrinolysis.  

SATA is delighted to endorse the first International Symposium for Abdominal Organ Transplant (ISAOT) in Santiago, Chile, June 8-9, 2023. 

This opportunity is presented by Dr. Klaus Torp at Mayo Clinic-Jacksonville (Founding member of SATA) who has supported the physician exchange program with the Clinica Alemanha in Santiago de Chile. Dr. Lucile Gignon (Faculty Anesthesiologist at the Clinica Alemanha in Santiago de Chile) is the local organizer of the meeting.

Attention liver transplant anesthesiologists and program directors!  SATA is offering free 6 month membership to fellows!  Please sign up by emailing sata@pacainc.com. We look forward to welcoming new fellow members!

Join the Vanguard Committee ***

Transplant Anesthesia Upcoming Meetings

 

SATA Meetings

 

SATA Tristate Regional Meeting – in person and virtual

March 25th, 2023, New York, NY

 

SATA Annual Meeting, 

April 17th, 2023, Denver, CO

 

Other Meetings: 

The 10th annual scientific meeting of the Korean Society of Transplantation Anesthesiologists (KSTA), March 18th, Seoul, Korea – in person and hybrid

Joint KSTA-SATA Session: 11:20 – 12:50 KST

 

IARS/AUA/SOCCA Annual Meeting – in person and hybrid

April 13-16th, 2023, Denver, CO

 

The 2023 International Congress of ILTS, ELITA and LICAGE

May 3-6, 2023; Rotterdam, Netherlands

 

American Transplant Congress (ATC) 2023 Annual Meeting

June 3-7, 2023, San Diego, CA

 

International Symposium for Abdominal Organ Transplant (ISAOT)

June 8-9, 2023, Santiago, Chile

 

Filed Under: Newsletter

Tristate Regional Transplant Anesthesiology Conference 2023

February 20, 2023 By Sergio

Learning objectives – On completion of this activity the participants will be able to

  1. Learn about the concept of frailty and its importance in evaluation/management and outcomes for abdominal transplant recipients
  2. Discuss indications and practical considerations for use of veno-venous bypass in liver transplantation and advanced hepatobiliary surgery
  3. Review strategies for prevention and treatment of acute kidney injury in liver transplantation
  4. Learn about strategies to improve graft quality in donation after circulatory determination of death in organ transplantation, including machine perfusion
  5. Review ethical and practical considerations in organ donation after circulatory determination of death
  6. Discuss administrative considerations in managing a transplant anesthesiology service line and fellowship

Target audience

Transplant anesthesiologists, intensivists, transplant surgeons, residents, and fellows.

Time and Location:

SATURDAY, MARCH 25TH, 2023: 9 AM – 2 PM, WEILL CORNELL MEDICINE

1300 YORK AVENUE, NEW YORK, NY 10065 WEILL AUDITORIUM (C-200)

 

Virtual Venue:

https://weillcornell.zoom.us/j/97750761082?from=addon

Meeting ID: 977 5076 1082

 

Schedule:

9:00 – 9:30: Breakfast and Welcome: Christine Lennon M.D., Weill Cornell Medicine

9:30 – 10:30: Perioperative considerations

Frailty in abdominal transplant – Joseph Scarpa, M.D. and Rohan Panchamia M.D., Weill Cornell Medicine

Veno-venous bypass in liver transplantation – Juan Rocca M.D., Weill Cornell Medicine

ICU Management: postoperative acute kidney injury in liver transplantation – Christopher Tam M.D., Montefiore Medical Center

10:30 – 10:45: Break

10:45 – 11:30: Donor considerations

DCD donation and NRP – Zeeshan Akhtar M.D., The Mount Sinai Hospital

DCD practical and ethical considerations –  Christine Lennon M.D., Weill Cornell Medicine

11:30 – 12:15: Lunch

12:15 – 1:15: Administrative considerations

Anesthesiologist as the perioperative physician: the transplant anesthesiology model –  Nikhil Chawla M.D., Yale New Haven Hospital

Transplant anesthesiology service considerations – Joseph Yeh M.D., NYU Langone Health

Transplant anesthesiology fellowship considerations – Natalie Smith M.D., The Mount Sinai Hospital

1:15 – 1:45: Keynote address: Tetsuro Sakai M.D., University of Pittsburgh Medical Center

1:45 – 2:00 Closing Remarks: Gebhard Wagener M.D., Columbia University Irving Medical Center

Registration Fees and Link:
Complimentary Registration if no CME credits are required
$30.00 for SATA and SCA Members – CME Credits Needed
$60.00 for Non-SATA and SCA Members – CME Credits Needed
 
https://sata2022.wufoo.com/forms/zid5tgc0d8hdb3/ 
 

Organizing committee members (alphabetical):

  • Ranjit Deshpande, MD, FCCM (Yale New Haven Hospital, New Haven, CT)
  • Christine Lennon, MD (Weill Cornell Medicine, New York, NY)
  • Marina Moguilevitch, MD (Montefiore Medical Center, Bronx, NY)
  • Natalie Smith, MD (The Mount Sinai Hospital, New York, NY)
  • Gebhard Wagener, MD (Columbia University Irving Medical Center, New York, NY)
  • Joseph Yeh, (NYU Langone Health, New York, NY)

 

Directions to Weill Auditorium (C-200)

Enter the medical school at 1300 York Avenue.

After you go through security, proceed to the second floor via the stairs or elevator.

As you exit the staircase, make a left and walk down the hall. C-200 will be on the right.

Filed Under: Meeting, Regional Meeting Media

2023 DMV Regional SATA Meeting

February 11, 2023 By Sergio

Program overview:

This SATA regional meeting will provide discussion of novel areas of interest in liver, heart, and lung
transplantation.

Learning objectives:

At the end of this session participants will be able to:
1. Determine the potential benefits and challenges of ECMO in liver, heart and lung transplantation
2. Understand risk and benefit of postponing abdominal closure after liver transplantation
3. Learn the different antimicrobial strategies adopted in abdominal and cardio-thoracic transplant
patients to protect them from infection in the perioperative period
4. Understand the potential complication of vascular cannulation for V-V bypass
5. Understand the challenges of managing blood products reserve for a patient with antibody
6. Determine the best approach to liver transplant for a patient with Severe AS

Target audience:

Anesthesiologists, Intensivists, Surgeons, Hepatologists, Cardiologists, Fellows,
Resident, Medical Students, Nurse anesthetists, Advanced Practice Nurses, Anesthesiologist Assistants,
Physician Assistants, and Nursing staff who are involved in the perioperative care of transplant patients.

Core Faculty

Lorenzo De Marchi, MD, FASE (Chair)
Professor of Clinical Anesthesia
MedStar-Georgetown University Hospital
Aliaksei Pustavoitau, MD, MHS, FCCM
Associate Professor of Anesthesiology and Critical Care Medicine
Johns Hopkins University
Katie Forkin, MD
Associate Professor of Anesthesiology
Division Chief, Liver Transplant Anesthesia
University of Virginia Health
Sergio Navarrete, DO
Assistant Professor
Virginia Commonwealth University

Additional Faculty listing:

Promise Ariyo, MD MPH
Assistant Professor
Divisions of Cardiac Anesthesia & Critical Care
Department of Anesthesiology & Critical Care Medicine
Johns Hopkins University

Zachary Janik, MD
Anesthesia Resident
Johns Hopkins University School of Medicine

Olivia S. Kates, MD
Assistant Professor of Medicine
Johns Hopkins University

Shane Ottman, MD
Assistant Professor of Surgery
Johns Hopkins University

Pedjman Radkani, MD
Assistant Professor of Surgery
MedStar-Georgetown University Hospital

Gregory Serrao, MD, MSE, FACC, FSCAI
Director, Mechanical Circulatory Support
Cardiac Catheterization Laboratory
Icahn School of Medicine at Mount Sinai

Benjamin Wilson, MD
Anesthesia Resident
MedStar-Georgetown University Hospital

Hamy Kassahun, MD
Anesthesia Resident
University of Virginia Health

 

SATA-DMV 2023 10:25 am – 3:30 pm

10:25 am – 10:30 am Welcome and Introduction – Lorenzo De Marchi, MD (MGUH)

10:30 am -11:20 am ECMO in Transplant – Moderator: Aliaksei Pustavoitau, MD (JHH)

10:30 am – 10:50 am ECMO in liver transplant – Gregory Serrao, MD (Mount Sinai)

10:50 am – 11:10 am ECMO in CT transplant – Promise Ariyo, MD (JHH)

11:10 am – 11:20 am Q&A

11:20 am – 11:30 am Presidential address

11:30 am – 11:35 am Break

11:35 am – 12:30 pm Management of open abdomen in Liver Transplant (Pro/ Con) – Moderator: Sergio Navarrete, DO (VCU)

11:35 am – 11:55 am Con – Pejman Radkani, MD (MGUH)

11:55 am – 12:15 pm Pro – Shane Ottmann, MD (JHH)

12:15 am – 12:35 pm The CCM Perspective – Aliaksei Pustavoitau (JHH)

12:35 pm – 12:50 pm Q&A

12:50 pm – 1:30 pm Lunch break

1:30 pm – 2:20 pm Third Session – Moderator: Lorenzo De Marchi, MD (MGUH)

1:50 pm – 2:10 pm Perioperative Antimicrobial Therapy in Abdominal Transplant – Olivia Kates, MD (JHH)

2:10 pm – 2:20 pm Q&A

 

2:20 pm – 2:30 pm Break

2:30 pm – 3:25 pm Challenging Cases – Moderator: Katherine Forkin, MD (UVA)

2:30 pm – 2:45 pm LDLT in a patient with Severe AS – Hamy Kassahun , MD (UVA)

2:45 pm – 3:00 pm Blood management for patients with antibodies-Zachary Janik,MD (JHH)

3:00 pm – 3:15 pm Complication V-V bypass cannulation – Ben Wilson, MD (MGUH)

3:15 pm – 3:25pm Q&A

 

3:25 pm – 3:30 pm Closing Remarks

Filed Under: Meeting, Regional Meeting Media

The 2023 Symposium of the Society for the Advancement of Transplant Anesthesia

February 6, 2023 By Sergio

In conjunction with the annual meeting of the International Anesthesia Research Society (IARS)

Note: SATA Council meeting on April 16

 

Monday April 17, 2023 (8 AM – 3:00 PM)

Location: Mineral A-C room on Level 3, Hyatt Regency Denver at Colorado Convention Center, 650 15th Street, Denver, CO 80202

 

Registration (with CME credit):

 https://sata2022.wufoo.com/forms/z1e9i2pz1p5x4o8/    or       https://tinyurl.com/mr2rn9ks

$50 for SATA, SOCCA and SCA members, $150 for non-members, free for trainees

 

7:30 am – 8:00 am Registration

 

8:00 am – 8:15 am Welcome and Introduction

  • Gebhard Wagener, President-elect – Columbia University, New York, NY

 

8:15 am – 9:15 am: Session 1: The Yin and Yang of coagulation (60 min)

Moderator: Alexandra Ruan – Stanford University, Stanford, CA

  • New models and new drugs in coagulation (20-25 min)
    • Art Bracey – Baylor College of Medicine
  • Anticoagulants and surgery: Stop, continue, reverse?
    • Abdominal transplant (10 min)
      • Manoj Iyer – The Ohio State University Wexner Medical Center
    • Thoracic transplant (SCA) (10 min)
      •  Kenichi Tanaka – The University of Oklahoma College of Medicine

 

9:15 am – 9:45 am: Coagulation debate (30 min)

  • Are ROTEM and Cryoprecipitate dangerous for liver transplants? (10 min)
    • Christine Nguyen-Buckley – University of California Los Angeles
  • Are PCC and Vit K dangerous for heart transplants? (10 min)
    • Jiapeng Huang – University of Louisville, Kentucky

 

9:45 am – 10:30 am: Session 2: Pain and analgesia for transplant surgeries (45 min)

  • Regional techniques for thoracic transplants and VADs (10 min)
    • Anis Dizdarevic – Columbia University, New York, NY
  • Indications and challenges to early extubation in the operating room (10 min)
    • Courtney Scott – Mayo Clinic Jacksonville, FL
  • Analgesia for living liver donors (KSA) (15 min)
    • Justin Ko – Sungkyunkwan University School of Medicine, Samsung Medical Center; Director of Scientific Affairs, Korean Society of Anesthesiologists – Seoul, Korea

 

10:30 am – 11:00 am: Break

 

11:00 am – 11:20 am State of the Society

  • Ted Sakai, President of SATA – University of Pittsburgh Medical Center, PA
    • (Introduction: Susan Mandell – McGovern Medical Center, Houston TX

 

11:20 am – 12:00 pm Case presentations

Moderator: Adrian Hendrickse – University of Colorado Denver, CO

  • Thoracic Transplant
    • Michelle Chen- Columbia University, New York, NY
    • Mentor: Andrea Miltiades – Columbia University, New York, NY
  • Abdominal transplant
    • Zach Fleissner – Mayo Clinic Jacksonville, FL
    • Mentor: Ryan Chadha – Mayo Clinic Jacksonville, FL

 

12:00 pm – 1:00 pm Session: What’s new in organ donation and allocation (60 min)

  • How is transplantation organized: past and future of UNOS and organ transplantation in the US (15-20 min)
    • Jennifer Prinz – CEO of Donor Alliance and Vice Chair of the OPTN Policy Committee
  • The impact of the new regulation of organ allocation on transplant practices (15-20 min)
    • Jim Pompeselli – University of Colorado Denver, CO
  • Deceased donor management and machine perfusion modalities (15 min)
    • Emily Vail – University of Pennsylvania, Philadelphia, PA

 

1:00 pm – 1:30 pm Break

 

1:30 pm – 2:30 Session: How and why do we maintain blood pressure and perfusion (45 min)

Moderator: Ana Fernandez-Bustamante – University of Colorado Denver, CO

  • Just a bystander organ? How do we protect the kidney? (15 min)
    • HT Lee – Columbia University, New York, NY
  • New kids on the block
    • Angiotensin (10 min)
      • Michael Bokoch – University of California San Francisco, CA
    • Terlipressin (in collaboration with the Society of Critical Care Anesthesiologist, SOCCA) (10 min)
      • Sathish Kumar, University of Michigan, Ann Arbor, MI

 

2:30 pm – 2:45 pm First SATA Research Award

  • SATA Research Committee
    • She- Lu Pai – Mayo Clinic Jacksonville, FL
    • Dieter Adelmann – University of California San Francisco, CA

 

2:45 pm – 3:00 pm Closing Remarks

  • Lorenzo De Marchi, SATA Secretary – MedStar Georgetown University Hospital

 

Filed Under: Announcements, Annual Meeting Media, Meeting

December 2022 Article of the Month

February 2, 2023 By Sergio

Alcohol-associated liver disease predicts increased post-liver transplant opioid use.

Abstract:

BACKGROUND: Alcohol-associated liver disease (ALD) is a rising indication for liver transplantation (LT). Prolonged opioid use after LT leads to increased graft loss and mortality. The aim is to determine if patients transplanted with a primary diagnosis of ALD had higher risk of post-LT opioid use (p-LTOU) compared to non-ALD patients.

METHODS: This is a retrospective study of patients who underwent LT between 2015 and 2018 at Medstar Georgetown Transplant Institute. Patients with prolonged hospitalization post-LT (>90 days), death within 90 days post-LT, and re-transplants were excluded.

RESULTS: Two hundred and ninety-seven patients were transplanted, among 29% for indications of ALD. ALD patients were younger (52 vs. 56 years), more likely to be male (76% vs. 61%), Caucasian (71% vs. 44%), have higher MELD (28.8+/-8.8 vs. 25+/-8.8), and psychiatric disease than non-ALD patients (P < .05). There was no difference in pre-LT use of opioids, tobacco, marijuana, or illicit drugs between ALD and non-ALD patients. Pre-LT opioid use (OR = 11.7, P < .001), ALD (OR = 2.5, P = .01), and MELD score (OR = .95, P = .02) independently predicted 90-day p-LTOU.

CONCLUSIONS: ALD, pre-LT opioid use, and MELD score independently predict p-LTOU. Special attention should be paid to identify post-LT prolonged opioid use in ALD patients.

Comments made by Cale Kassel M.D., FASA

 

Summary:

In this retrospective study, the Johnson-Laghi et al reviewed patients undergoing liver transplantation focusing on patients with known alcoholic liver disease and previous opioid use prior to transplantation. As has been described, the use of pre-operative opioids is associated with worse outcomes in other surgical procedures. The authors sought to identify if post-LT opioid use (p-LTOU) was greater in patients with alcoholic liver disease (ALD) compared to those without alcoholic liver disease.

Patient demographic data included diagnosis of psychiatric disease, use of psychiatric medications, use of illicit drugs, use of benzodiazepines, use of marijuana, prior alcoholic rehabilitation, and legal encounters related to alcohol (DUI). Use of pre-operative opioids included use both scheduled and as needed within the three months prior to transplantation. The total dose was converted to morphine equivalents for comparison.

Overall, opioid use post-LT was more common with patients with ALD compared to those without at 30, 60, and 90 days. At 90 days, 44% of ALD patients were taking opioids compared to 27% of non-ALD patients (p = 0.004). Multi-variate logistic regression demonstrated pre-LT opioid use, primary diagnosis of ALD, and lower MELD predicted 90-day post-LT opioid use.

Further analysis showed specific risk factors for p-LTOU at 60 days to include living alone. As the authors noted, this shows the importance of good social support for patients evaluated for LT. This was not a significant variable at 90 days however.

As the authors noted, more research is needed on this topic to further identify risk factors for opioid use following LT. Additionally, this is an area for anesthesiologist involved in the listing process to add value. Opioid tapering prior to LT may provide benefit for patients. Identifying patients with any patient who take opioids, can allow for early intervention including opioid tapering.

Filed Under: Article of the Month, Education

Fall 2022 Newsletter

January 23, 2023 By Sergio

 

In the Transplant News:

Flora Simmons, MD
 

Policy Changes Improve Access For the Highest Acuity Patients

The data reports on the first two years of the new liver and intestinal allocation policy based on acuity circles. The policy was designed to increase equity consistency in transplant access for the most urgent candidates. Key improvements include significantly increased liver transplants for candidates with MELD scores of 29 or higher as well as those in Status 1A or 1B. Notably, the geographic variability in medical urgency scores at transplant has decreased at the levels of donation service area, state, and region. 

 

UNOS Organ Tracking Service Is Now Underway

26% of all organ procurement organizations (OPOs) are now utilizing the UNOS organ tracking service to monitor organs in transit. The UNOS Organ Tracking Service is used to track organs from packaging to final delivery to the recipient team. The device pings every two minutes to provide real time updates.

 

U.S. Leads The World In Transplants With Its 1 Million Transplant Milestone

The U.S. has reached a historic 1 million organ transplantations. This milestone was made possible due to the expansion of more equitable organ allocation policies, expanding the donor pool, and advancements of organ preservation techniques. 

 

OPTN: The Latest Data On Organ Donation And Transplants In The U.S.

Find comprehensive reports and metrics at the regional and national level. Learn how the OPTN ensures equity for waitlisted patients. 

Research Updates and Interesting Articles

Michael Trostler, MD

1. Influence of anesthesia type on post-reperfusion syndrome during liver transplantation: a single center retrospective study   

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.

2. Outcomes of Bariatric Surgery Before, During, and After Solid Organ Transplantation  

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.

3. Orthotopic Transplantation of the Full-length Porcine Intestine After Normothermic Machine Perfusion  

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.

4. Safety of Intraoperative Blood Salvage During Liver Transplantation in Patients With Hepatocellular Carcinoma A Systematic Review and Meta-analysis  

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.

5. Regional and National Trends of Adult Living Donor Liver Transplantation in the United States Over the Last Two Decades   

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.

Special Topics
Alex Stoker, MD

Intrapulmonary shunting and paradoxical air embolism during liver transplantation

Patients with end-stage liver disease often have evidence of intrapulmonary shunting (IPS) due to pulmonary vascular dilation with a prevalence estimated to be between 13 and 47%. IPS may be detected preoperatively with transthoracic echocardiography as air bubbles appearing in the left atrium 5 to 6 cardiac cycles after first appearing in the right atrium. Despite the frequency of intrapulmonary shunting in patients presenting for liver transplantation, cases of severe paradoxical air embolism (PAE) causing hemodynamic collapse are rarely reported in the literature ( Badenoch 2017, Smart 2021). With the increasing use of TEE during liver transplantation, there is opportunity to diagnose PAE by visualizing air passing to the left atrium from the pulmonary veins (see figure below). A PAE has the potential to travel to the coronary arteries or cerebral circulation and should be considered as a possible cause of organ dysfunction or hemodynamic perturbations during liver transplantation.

Mid esophageal view of the left atrium and left ventricle with air bubbles seen emerging from the left upper pulmonary vein.  LA, left atrium; LV, left ventricle; LUPV, left upper pulmonary vein.

In the Spotlight: Saint Louis University Medical Center Transplant Program

David Rosenfeld, MD

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. 

Announcements

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 demarchilorenzo@yahoo.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.  

Application/Grant Cycle:

  • 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

SATA 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

Other Meetings: 

The Liver Meeting – aasld.org, November 4-8, 2022, Washington, DC

The 2023 International Congress of ILTS, ELITA and LICAGE

May 3-6, 2023; Rotterdam, Netherlands

American Transplant Congress (ATC) 2023 Annual Meeting

June 3-7, 2023, San Diego, CA

Filed Under: Newsletter

  • Go to page 1
  • Go to page 2
  • Go to page 3
  • Interim pages omitted …
  • Go to page 5
  • Go to Next Page »

Primary Sidebar

Information for Authors

President’s Message

Gebhard Wagener, MD

SATA President

Read more

Contact Us

Current Member:

Michael Kaufman, MD

Copyright © 2025 Society for the Advancement of Transplant Anesthesia (SATA) - Powered by: Top Shelf Design