SATA

Society for the Advancement of Transplant Anesthesia

Sergio

Lung transplant management in COVID-19 patients

By

Recognizing inadvertent central venous catheter complications and effective management options for patient with COVID-19 infection requiring bilateral lung transplant

 

Ahmad R. Parniani, MD and Yong G. Peng, MD, PhD, FASE, FASA

Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL

 

Summary: We describe the case of a 50-year-old man with COVID-19 who underwent a successful bilateral lung transplant. We also review the anesthetic management strategies for these patients including the role of ECMO and discuss complications associated with central venous catheter placement for lung transplant.

 

After reviewing the case, readers will be able to:

  • Identify the selection criteria of patients with severe COVID-19 for lung transplant.
  • Recognize the complications associated with central venous catheter placement for lung transplant.
  • Describe the pathophysiology of cardiac tamponade and management strategies.
  • Understand the role of ECMO in the management of patients with COVID-19.
  • Review the anesthetic challenges of patients infected with COVID-19 who are undergoing lung transplant.

 

Case   

            We describe the case of a 50-year-old man with a past medical history of prostate cancer and prostatectomy, chronic back pain, hypothyroidism, and hypertension. He tested positive for COVID-19 on April 26, 2021 after developing shortness of breath and cough and was sent home from the emergency department for quarantine. However, his condition deteriorated and he was admitted to the hospital 5 days later. He received a combination of remdesivir, dexamethasone, convalescent plasma, and tocilizumab as recommended medical therapy. Unfortunately, on hospital day 20 he was intubated and underwent a percutaneous tracheostomy on hospital day 34. Due to increasing ventilatory requirements, including positive end-expiratory pressure (PEEP) of 24 cm H2O with 100% fraction of inspired oxygen (FiO2), he was placed in the prone position with little improvement. The patient was subsequently placed on venovenous extracorporeal membrane oxygenation (VV-ECMO) on hospital day 60 and transferred to our facility to be evaluated for lung transplant. Given his worsening right ventricular function, he underwent conversion of VV-ECMO to veno-arterio-venous ECMO (VAV-ECMO) on hospital day 64. Epoprostenol and inhaled nitric oxide were continued to treat his pulmonary hypertension and support his worsening right ventricular systolic function. Continuous veno-venous hemofiltration was also initiated given his worsening acute kidney injury.

The patient underwent lung transplant evaluation during his hospital stay and was listed as a lung transplant candidate on August 27, 2021. On September 26, 2021, he underwent a bilateral lung transplant. He was transported to the operating room on VAV-ECMO. Anesthesia was induced with 250 mcg of fentanyl, 130 mg of propofol, and 100 mg of rocuronium. He was intubated orally with a 41-Fr left double-lumen endotracheal tube and the tracheostomy was removed. A transesophageal echocardiography (TEE) probe was inserted for intraoperative monitoring.

Before central venous catheter placement, the left side of his neck was scanned with the ultrasound probe because the ECMO cannulation was in place in his right internal jugular (IJ) vein. However, we could not identify the patent lumen of the left IJ vein (Figure 1).

Figure 1.

As a result, we decided to obtain central venous access through the left subclavian vein. A 9-Fr introducer catheter was successfully placed after one attempt and no resistance was encountered during the insertion. Shortly after the central venous catheter placement, the patient became hemodynamically unstable and unresponsive to multiple vasopressor boluses, including epinephrine. We administered fluids and medication boluses through the newly placed left subclavian central venous catheter. TEE was immediately used to assess his cardiac function and showed an enlarging pericardial effusion with tamponade physiology. At this point, the surgical team was immediately called and resuscitation with intravenous (IV) fluids and epinephrine was continued. We noticed that our boluses of epinephrine were not effective in maintaining his blood pressure, so we switched our infusions and boluses from the central venous catheter into the indwelling peripherally inserted central catheter (PICC). We also started transfusing blood through the ECMO circuit. A peripheral IV was inserted in his left external jugular vein and resuscitation was continued.

A clamshell incision was performed and the surgical exposure entered the pleural cavity on the fourth intercostal space. The pericardium was then opened, and a large amount of blood was evacuated. Afterward, the patient’s condition stabilized, the arterial line tracing became pulsatile once again, and the heart was filling and ejecting appropriately. We noted that the central venous catheter coming from the left subclavian vein tracked outside of the vessel on the thoracic inlet, perforating the pericardium and creating a small tear on the adventitia of the aorta (Figure 2).

Figure 2.

Vasa-vasorum from the aorta adventitia was copiously bleeding, which was controlled with bovie coagulation. The patient became hemodynamically stable and TEE confirmed that his bilateral ventricular function was improving. The surgical team could not access his left femoral vein because ultrasonography revealed thrombosis of the vein.  The case proceeded and a bilateral lung transplant was performed successfully. The patient was transported to the intensive care unit (ICU) postoperatively in a hemodynamically stable condition. He was decannulated from ECMO 1 week after his lung transplant and his tracheostomy was eventually removed. He remained stable on room air and was transferred to rehabilitation facility for further recovery.

 

What are the current medical therapies available for COVID-19 infection?

Randomized placebo-controlled trials have shown that remdsesivir has enhanced the recovery of hospitalized patients.1,2 Another randomized clinical trial demonstrated that a single dose of bamlanivimab (monoclonal antibody) reduced the viral load in outpatients.2 A large randomized controlled trial showed a mortality benefit with dexamethasone in hospitalized patients requiring oxygen.2 A combination of medical treatments is considered the most effective therapy for patients with COVID-19.

What are the potential treatments for refractory hypoxemia in patients with COVID-19 acute respiratory distress syndrome (ARDS)?

Prone positioning should be considered in patients with PaO2:FiO2 <150 mm Hg during respiration and FiO2 of 0.6 despite an appropriate PEEP. However, prone positioning requires equipment and training that may not be available at some medical centers. Inhaled pulmonary vasodilators such as inhaled nitric oxide can also improve oxygenation in refractory respiratory failure. ECMO can also be considered as an alternative rescue therapy for refractory respiratory failure; however, ECMO is associated with an increased risk of bleeding and requires extensive resources and trained staff.1

What are the ventilatory management strategies in patients with COVID-19 who are intubated?

Autopsies performed on patients with severe COVID-19 have revealed the presence of diffuse alveolar damage, which is a hallmark of ARDS. Essential ventilatory management should focus on avoiding further ventilator-induced lung injury. The main goals are reducing alveolar overdistension, hyperoxia, and cyclical alveolar collapse. Lung-protective ventilation is used by setting the ventilator for tidal volume at 6 mL/kg of predicted body weight. To prevent alveolar overdistention, the plateau pressure should not exceed 30 cm H2O. PEEP prevents alveolar collapse and facilitates the recruitment of unstable lung regions.2

What are the proposed criteria for the selection of patients with severe COVID-19 for lung transplant?

The general criteria are age younger than 65 to 70 years, preference for single organ failure, no malignancy, no substance misuse, and postoperative social support. Other criteria include healthy neurocognitive status, general condition (if the patient is participating in physical therapy while hospitalized), and evidence of irreversible lung damage.1

How long after the onset of ARDS secondary to COVID-19 should lung transplant be considered?

The exact time needed to determine irreversibility is not clear, but the recommendation is to wait approximately 6 weeks after ARDS onset. Ideally, when lung recovery is deemed unlikely after ARDS onset, lung transplant should be considered. Exceptions to these criteria include severe pulmonary complications such as severe pulmonary hypertension with concomitant right ventricular failure, refractory nosocomial pneumonias, or recurrent pneumothoraces that cannot be medically managed with or without ECMO.1

What are some of the concerns regarding ongoing infection at the time of transplant and reinfection of the allograft?

The risk of reinfection should be carefully reviewed as part of the pretransplant evaluation workup. Studies suggest that it is rare to detect replicating virus more than 10 days after infection with SARS-CoV-2 even though the PCR result may remain positive for weeks after infectivity. In cases where the PCR remains positive for extended durations, high-cycle thresholds are seen (Ct >24), but infectivity is usually not evident.1

What are some considerations regarding deep sedation and neuromuscular blockade effects on post-transplant outcomes?

As soon as 2 to 3 days after the start of mechanical ventilation, the diaphragm can lose approximately 50% of its fibers. This can have a significant impact on post-transplant recovery. As a result, weaning of sedation and participation in physical therapy should be highly encouraged.1 In addition, if patients can be weaned from sedation, they can actively participate in discussions regarding the direction of their care and therapeutic goals.

Why are patients with COVID-19 more prone to bleeding during their hospital stay?

ARDS is associated with a significantly increased bleeding risk. In addition, prolonged ECMO can lead to platelet dysfunction in a significant portion of patients. Pleural adhesions and the fragile tissue of these patients increase the risk of intraoperative bleeding.2

What is the approach for placing a subclavian central venous catheter using anatomic landmarks?

Starting 2 cm lateral and 2 cm caudal to the bend of the clavicle, a needle is inserted through the skin at a 30° angle toward the sternal notch. We recommend placing a finger of the nondominant hand in the sternal notch to help find the landmark. Once the needle is under the skin, the needle and syringe are lowered to run parallel to but beneath the clavicle. Access to the vein typically happens just beneath the clavicle, but it may be several centimeters under the skin.3 Medical professionals should be alert to possible complications such as pneumothorax, vascular injury leading to hemothorax, and other inadvertent injury to the adjacent thoracic structures.  

How frequent are complications associated with central venous catheter placement? 

Central venous catheter placement is an invasive procedure that requires planning and an organized approach. There are a number of potential complications associated with central venous catheter placement, most commonly infection, bleeding, pneumothorax, hemothorax, and vascular injury. A prospective randomized trial of patients undergoing subclavian central venous catheter placement at the University of Texas examined the rate of complications. There was a 6% rate of misplacement, 3.7% rate of arterial puncture, 1.5% rate of pneumothorax, and 0.6% rate of mediastinal hematoma.4 Another retrospective chart review was performed for all central venous catheters placed between November 1, 2012, and June 30, 2013, at MedStar Washington Hospital Center (MWHC). In that study, the rate of arterial injury was 1.3% of subclavian central venous catheters, 0.4% of IJ central venous catheters, and 1.4% of femoral central venous catheters.4,5

What is the pathophysiology of pericardial tamponade?

The primary abnormality in cardiac tamponade is impaired diastolic filling of the heart. This is caused by increased intrapericardial pressure that leads to compression of the atria and ventricles. Diastolic filling pressures increase and start to equilibrate with all cardiac chambers. Cardiac filling is reduced, resulting in decreased stroke volume, cardiac output, and systemic blood pressure. Compensatory mechanisms attempt to counteract the decrease in stroke volume by increasing systemic vasoconstriction and tachycardia.6

What are the treatment options and hemodynamic goals during management of patients with pericardial tamponade?

Definitive treatment is emergent drainage and/or relief of the pericardial compression. This can be achieved through pericardiocentesis or surgical decompression. The highlights of hemodynamic management include maintaining contractility and systemic vascular resistance with inotropes and vasopressors. Preload should be maintained with IV fluids and avoiding large tidal volumes of positive pressure ventilation. Additionally, reductions in heart rate should be strongly prohibited to preserve cardiac output because these patients have a fixed and reduced stroke volume.6

What is the role of ECMO in the management of patients with COVID-19?

VV-ECMO is a complicated and labor-intensive tool that is used in severe hypoxemic respiratory failure refractory to conventional mainstays of medical therapy including mechanical ventilation with optimal PEEP, neuromuscular blockade, and prone positioning. VA-ECMO is different from VV-ECMO in that it is typically initiated for patients in cardiac or circulatory failure with or without concomitant respiratory failure. VV-ECMO is commonly considered as a bridge to specific endpoints, such as recovery or lung transplant. Unfortunately, VV-ECMO may also become a bridge to nowhere; a careful assessment of the end goals of therapy is warranted.1,6

What are some of the complications associated with ECMO in patients with COVID-19?

ECMO is associated with thrombotic and hemorrhagic complications. A high proportion of patients with COVID-19 develop life-threatening thrombotic complications. In an autopsy series, most of the patients were diagnosed with deep vein thrombosis (DVT) or pulmonary embolisms. The mechanism of this hypercoagulable state is related to the major systemic inflammatory response along with endothelial dysfunction.7 The combination of a prothrombotic state and long-term use of ECMO cannulas can increase the risk of blood clots. In 80% of patients on ECMO, heparin can be used as a systemic anticoagulant. In patients with COVID-19 or heparin-induced thrombocytopenia (HIT), bivalirudin may be considered as an alternative anticoagulation strategy. Activated clotting times (ACTs) of 160 to 180 s for VV-ECMO and 180 to 220 s for VA-ECMO are necessary to avoid thrombotic complications. Other complications include vascular injury, infections, kidney failure, stroke, and mechanical equipment failure. Closely monitoring ECMO function is essential to the success of this unique bridge therapy.8

 

 

References

  1. Bharat A, Machuca TN, Querrey M, Kurihara C, Garza-Castillon R Jr, Kim S, Manerikar A, Pelaez A, Pipkin M, Shahmohammadi A, Rackauskas M, Kg SR, Balakrishnan KR, Jindal A, Schaheen L, Hashimi S, Buddhdev B, Arjuna A, Rosso L, Palleschi A, Lang C, Jaksch P, Budinger GRS, Nosotti M, Hoetzenecker K. Early outcomes after lung transplantation for severe COVID-19: a series of the first consecutive cases from four countries. Lancet Respir Med. 2021 May;9(5):487–497. doi: 10.1016/S2213-2600(21)00077-1. Epub 2021 Mar 31. PMID: 33811829; PMCID: PMC8012035.
  2. Berlin DA, Gulick RM, Martinez FJ. Severe Covid-19. N Engl J Med. 2020 Dec 17;383(25):2451–2460. doi: 10.1056/NEJMcp2009575. Epub 2020 May 15. PMID: 32412710.
  3. Braner DA, Lai S, Eman S, Tegtmeyer K. Videos in clinical medicine. Central venous catheterization–subclavian vein. N Engl J Med. 2007 Dec 13;357(24):e26. doi: 10.1056/NEJMvcm074357. PMID: 18077803.
  4. Mansfield PF, Hohn DC, Fornage BD, Gregurich MA, Ota DM. Complications and failures of subclavian-vein catheterization. N Engl J Med. 1994 Dec 29;331(26):1735–1738. doi: 10.1056/NEJM199412293312602. PMID: 7984193.
  5. Bell J, Goyal M, Long S, Kumar A, Friedrich J, Garfinkel J, Chung S, Fitzgibbons S. Anatomic site-specific complication rates for central venous catheter insertions. J Intensive Care Med. 2020 Sep;35(9):869–874. doi: 10.1177/0885066618795126. Epub 2018 Sep 19. PMID: 30231668.
  6. Gravlee GP. Hensley’s Practical Approach to Cardiothoracic Anesthesia. 6th ed. Wolters Klumer; 2018.
  7. Falcoz PE, Monnier A, Puyraveau M, Perrier S, Ludes PO, Olland A, Mertes PM, Schneider F, Helms J, Meziani F. Extracorporeal membrane oxygenation for critically ill patients with COVID-19-related acute respiratory distress syndrome: worth the effort? Am J Respir Crit Care Med. 2020 Aug 1;202(3):460–463. doi: 10.1164/rccm.202004-1370LE. PMID: 32543208; PMCID: PMC7397791.
  8. Huang J, Firestone S, Moffatt-Bruce S, Tibi P, Shore-Lesserson L. 2021 Clinical Practice Guidelines for Anesthesiologists on Patient Blood Management in Cardiac Surgery. J Cardiothorac Vasc Anesth. 2021 Dec;35(12):3493–3495. doi: 10.1053/j.jvca.2021.09.032. Epub 2021 Sep 24. PMID: 34654633.

 

 

 

The 2022 Symposium of the Society for the Advancement of Transplant Anesthesia

By

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

Place: Zoom Platform (virtual)

Time: Monday, March 21, 2022 (10:00 AM to 4:35 PM EST)  

Course Syllabus

Program overview:

This SATA National meeting is a virtual meeting that has been designed to provide a broad spectrum of clinicians with a review of the latest updates on a variety of intra-operative and critical care management topics that involve abdominal and thoracic transplant patients. 

Learning objectives:

  1. Discuss clinical approaches in the perioperative management of liver transplant patients with metabolic syndromes (Pediatric) or obesity (adult)
  2. Discuss clinical management of adult liver transplant patients with ECMO support 
  3. Review the current practice management of liver transplantation anesthesia in adult and pediatric population based on National Surveys and UNOS organ allocation system
  4. Share the experience as Director of adult liver transplantation anesthesia to seek a better practice management
  5. Discuss the importance of the national anesthesia database in transplant anesthesia research 
  6. Debate the pros and cons of the use of opioids for liver transplantation recipients
  7. Review current practices in thoracic transplantation anesthesia in the area of COVID
  8. Review current practices of DCD donors on heart transplantation and lung transplantation for the patients with severe pulmonary hypertension 

 

Target audience: 

Specialists working in the area of organ transplantation (ex., transplant anesthesiologists, intensivists, transplant surgeons, other transplant medicine specialists, and CRNAs); Trainees (ex., residents, fellows); Students (medical students, nursing students)

Accreditation and CME credit designation: 

In support of improving patient care, this activity has been planned and implemented by the University of Pittsburgh and SATA. The University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

The University of Pittsburgh Medical Center designates this live activity for a maximum of 5.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To claim your CME: http://cce.upmc.com/sata-march-21-2022

Program committee members: 

  • Tetsuro Sakai, MD, PhD, MHA (University of Pittsburgh)
  • Gebhard Wagener MD (Columbia University Irving Medical Center)

Platform:  Zoom Webinar (address and password will be provided at the time of registration)

Registration:  SATA 2022 Symposium – Registration

Registration Fee: 

    • SATA members or SCA members: $50
    • Non-SATA members: $100
    • Free if:
    • Lecturers and moderators of the meeting 

 

10:00 – 10:05:              Welcome and Introduction of SATA

Gebhard Wagener MD (Columbia University Irving Medical Center)

 

10: 05 – 11:05:            Panel-1: New Topics in Abdominal Transplant Anesthesiology

                                          Moderator: Adrian Hendrickse MD, MMEd (University of Colorado)

  • Considerations for liver transplant in metabolic syndromes (SPA)

Andrew J Costandi, MD, MMM (Children’s Hospital Los Angeles)

In collaboration with the Society for Pediatric Anesthesia (SPA)

  • ECMO and Liver Transplantation (SOCCA): getting out of the OR is not everything

Lovekesh Arora, MBBS, MD (University of Iowa)

In collaboration with the Society of Critical Care Anesthesiologists (SOCCA)

  • Transplantation and the obese patient

Katie Forkin, MD (University of Virginia)

 

11:05 – 12:15:           Panel-2: The Practice of Transplant Anesthesiology

Moderator: Ranjit Deshpande, MD (Yale University)

  • National LT practice survey: adult (12 min)

Cara Crouch, MD (University of Colorado)

  • National LT practice survey: pediatrics (12 min)

Marina Moguilevitch, MD (Montefiore Medical Center)

  • Adult liver transplantation anesthesia practice management and the role of the transplant anesthesia director (12 min)

Aalok Kacha, MD, PhD (University of Chicago)

  • UNOS and organ allocation: adult and pediatrics (8 min)

Gebhard Wagener, MD (Columbia University Irving Medical Center)

 

12:15- 12:25 :           Break

 

12:25 – 12:35: SATA President Address

Tetsuro Sakai, MD, PhD, MHA, FASA (University of Pittsburgh)

 

12:35 – 13:35:          Keynote Address

Moderator:      Lorenzo De Marchi, MD (MedStar Georgetown University Hospital)

How do we use data to advance research and clinical practice in transplantation

Dieter Adelmann, MD (University of California – San Francisco)

 

13:35 – 14:20:         Pro/Con Debate

Moderators:    Ramona Nicolau-Raducu, MD, PhD (University of Miami)

                                          Sher-Lu Pai, MD (Mayo Clinic Jacksonville)

My goal is to avoid perioperative opioids for adult liver transplant recipients

  • Pro: Natalie Smith, MD (Icahn School of Medicine at Mt. Sinai)
  • Con: Sathish Kumar, MD (University of Michigan)

 

14:20- 14:30 :            Break

 

14:30 – 15:30:         Panel-3: Thoracic Organ Transplantation

                            Moderators:    Barbara Wilkey, MD (University of Colorado)

Kathir Subramaniam, MD, MPH (University of Pittsburgh)

  • DCD Transplantation: what is it and is it feasible for heart transplants?

Megan Chacon, MD (University of Nebraska Medical Center)

  • Lung transplant for pulmonary hypertension and the role of circulatory support

Andrea Miltiades, MD (Columbia University Irving Medical Center)

  • Thoracic Transplantation for COVID-19

Yong Peng, MD (University of Florida)

 

15:30  – 15:35:        Closing remarks

Jiapeng Huang, MD (SATA Treasurer, University of Louisville)

 

15:35  – 16:35:        Council meeting

Open to members

 

Faculty Disclosure

All individuals in a position to control the content of this education activity have disclosed all financial relationships with any companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. All of the relevant financial relationships for the individuals listed below have been mitigated:

  • Dieter Adelmann, MD: Haemonetics Inc (Grant/Research Support)
  • Tetsuro Sakai, MD, PhD, MHA: Springer Inc. (Book royalty), Haemonetics Inc (Grant/Research Support)
  • Kathir Subramaniam, MD, MPH: National Institute of Health (Site PI; Grants for institution)/Haemonetics/Edwards Life Sciences (Site Co PI; Institution)

No other members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships with any companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Disclaimer Statement

The information presented at this CME program represents the views and opinions of the individual presenters. It does not constitute the opinion or endorsement of, or promotion by, the UPMC Center for Continuing Education in the Health Sciences, UPMC / University of Pittsburgh Medical Center or Affiliates and University of Pittsburgh School of Medicine.  Reasonable efforts have been made to prepare the educational subject matter in a balanced, unbiased fashion and in compliance with regulatory requirements. However, each program attendee must always use their own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions, including, without limitation, FDA-approved uses and any off-label uses.

Midwest SATA Conference 2022

By

The MidWEST SATA Meeting

Saturday, JANUARY, 22, 2022

08:55 Am – 12:30 PM (CST)

 

Course Syllabus (updated)

Program overview:

This SATA regional meeting is to provide the audience the updated knowledge on several critical management issues in liver, heart and thoracic transplant patients.

 

Learning objectives:

At the end of this session participants will be able to

 

  1. Determine immediate and long-term outcome differences in the liver transplant recipients between living donor and brain-dead donor
  2. Analyze the importance of intraoperative echo cardiography and POCUS in liver transplantation
  3. List advantages of various regional anesthesia techniques in lung transplantation
  4. Determine the role of various extra corporeal cardiopulmonary support in lung transplantation
  5. Understand the current status of heart transplantation in DCD donors
  6. Identify potential benefits and challenges with ERAS in heart transplantation
  7. Identify perioperative contributing factors for the development of early graft dysfunction following heart transplantation

 

Target audience:

Anesthesiologists, intensivists, surgeons, 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.

 

Faculty listing

 

Elizabeth A. Townsend, MD, PhD

Clinical Instructor,

Department of Anesthesiology,

University of Wisconsin,

Madison, WI

 

Richa Dhawan, MD

Clinical Associate Professor,

Department of Anesthesia and Critical Care,

University of Chicago, Chicago, IL

 

Megan Chacon, MD

Associate Professor,

Department of Anesthesiology,

University of Nebraska Medical Center,

Omaha, NE

 

Prema Raj Jeyaraj, MMed, FRCS, FAMS

Senior Consultant, Professor of Surgery,

Director Sing Health Transplant,

Deputy Director National Liver Transplant Program, Singapore

Katherine L. Kozarek, MD

Assistant Professor,

Department of Anesthesiology,

University of Wisconsin,

Madison, WI

 

Michael B. Majewski, MD

Associate Professor,

Department of Anesthesiology and Perioperative Medicine,

Loyola University Medical Center,

Chicago, IL

 

Sundar Reddy, MD, MBA

Clinical Associate Professor

Director Transplant Anesthesia

Department of Anesthesiology

University of Iowa,

Iowa City, IA

 

 

Sudhakar Subramani, MD, MMed, FASE

Clinical Associate Professor,

Department of Anesthesiology,

University of Iowa,

Iowa city, IA

 

 

Daniel Lotz, MD

Associate Professor,

Department of Anesthesiology,

University of Minnesota,

Minneapolis, MN

 

Kalpaj R. Parekh, MD

Professor of Surgery

Surgical Director Lung Transplant Program,

Interim Chair, Department of Cardiothoracic Surgery,

University of Iowa,

Iowa City, IA

 

Tetsuro Sakai, MD, PhD, MHA, FASA

President SATA,

Professor, Vice Chair for Professional Development,

Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center

Pittsburgh, PA

 

Michael Viray, MD

Clinical Assistant Professor

Division of Heart failure program

University of Iowa,

Iowa City, IA

 

Accreditation and CME credit designation:

SATA (The Society for the Advancement of Transplant Anesthesia), University of Pittsburgh Medical Center

 

Program organizing institution  

University of Iowa (Meeting Chair: Sudhakar Subramani, MD, MMed, FASE)

 

Platform: https://pitt.zoom.us/meeting/register/tJMufumqqjwqE9bIoWx58RmECtT1VKEU57K3

Password will be provided upon registration below

 

Registration:  https://cce.upmc.com/midwest-sata-meeting (UPMC CME office)

 

Registration Fee:

  • US $30.00 at registration to SATA via cce.upmc.edu, if you need CME credits
  • Free registration for:
    • Current SATA members and members of the Society of Cardiovascular Anesthesiologists (SCA)
    • Lecturers and moderators of the meeting
    • Trainees, medical students, international medical personals, or nursing specialist who do not need CME credits

 

PROGRAM

 

8:55 AM – 9:00 AM        Welcome and Introduction

                                              Sudhakar Subramani, MD, MMed, FASE

 

9:00 AM – 9:50 AM       Adult Liver Transplantation Session (Moderator: Sundar Reddy, MD, MBA)

                                                           

9:00 AM-9:25 AM            Outcome differences between living and brain-dead donor in liver

                                              transplantation

                                           Prema Raj Jeyaraj, MMed, FRCS, FAMS

                                             

9:25 AM -9:50 AM         Impactness of Echocardiography in liver transplantation

                                           Elizabeth A. Townsend, MD, PhD

                                         

9:50 AM – 10.40 AM      Lung Transplantation Session (Moderator: Kalpaj R. Parekh, MD)

 

9:50 AM – 10:15 AM       Updates on regional anesthesia in lung transplantation

                                              Michael B. Majewski, MD

 

10:15 AM – 10:40 AM    Current role of extracorporeal cardio pulmonary support in lung 

                                            transplantation

                                            Sudhakar Subramani, MD, MMed, FASE

 

10:40 AM – 10:45 AM    SATA President Address

                                              Tetsuro Sakai, MD, PhD, MHA, FASA

 

10:45 AM – 10:55 AM     Break

 

10:55 AM – 12:20 PM    Heart Transplantation Session

                                              (Moderators: Katherine L. Kozarek, MD & Michael Viray, MD)

 

10:55 AM – 11:20 am    Update on Heart Transplantation of DCD Donors with the

                                              Normothermic Regional Perfusion Technique.

                                            Megan Chacon, MD

 

11:20 AM – 11:55 AM     Current Status of ERAS in Heart Transplantation

                                            Daniel Lotz, MD

 

11:55 AM – 12.20 PM     Perioperative Predictors of Early Graft Dysfunction Following

                                            Heart Transplantation

                                            Richa Dhawan, MD

 

12:20 PM – 12:30 PM    Closing Remarks

                                           Sudhakar Subramani, MD, MMed, FASE

 

Continuing Education Credit

In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

 

Physician (CME)

The University of Pittsburgh designates this live activity for a maximum of 3.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Other Health Care Professionals

Other health care professionals will receive a certification of attendance confirming the number of contact hours commensurate with the extent of participation in this activity. 

 

Faculty Disclosure

All individuals in a position to control the content of this education activity including members of the planning committee, speakers, presenters, authors, and/or content reviewers have disclosed all relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients.

The following relevant financial relationships were disclosed:

  • Richa Dhawan, MD (Renibus Therapeutics, INC)
  • Tetsuro Sakai, MD, PhD, MHA (Book royalty, Springer Inc.)

No other planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

  

Disclaimer Statement

The information presented at this CME program represents the views and opinions of the individual presenters, and does not constitute the opinion or endorsement of, or promotion by, the UPMC Center for Continuing Education in the Health Sciences, UPMC / University of Pittsburgh Medical Center or Affiliates and University of Pittsburgh School of Medicine.  Reasonable efforts have been taken intending for educational subject matter to be presented in a balanced, unbiased fashion and in compliance with regulatory requirements. However, each program attendee must always use his/her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses.

Winter 2021 Newsletter

By

In the Transplant News:

Flora Simmons, MD

UNOS Updates

  • ASTS Position Statement On The Role Of COVID-19 Vaccination For Transplant Candidates And Recipients: The American Society of Transplant Surgeons continues to recommend routine vaccination for all organ recipients (along with timely boosters). It also recommends vaccines for those on the waiting list, if possible. Read more at the ASTS Position Statement. 
  • Kidney Transplants Increase Across All Populations Following Policy Changes: Changes to kidney allocation were made in March of this year with the goal of improving access to organs and equality. Recent data shows that kidney transplants for all age groups, blood types, CPRA, and diagnoses have increased following the implementation of these new policies.  Read more at the UNOS News Section. 
  • Second Phase Of National DCD Procurement Collaborative Project Ready To Launch: UNOS has launched the second phase of a national collaborative improvement project to help organ procurement organizations (OPOs) identify and share effective practices related to recovery of donation after circulatory death (DCD) organs. Read more at the UNOS News Section.

In the Spotlight: The Miami Transplant Institute (MTI)

David Rosenfeld, MD

An affiliation between Jackson Health System and UHealth-the University of Miami Health System.

In this month’s feature we learn from Drs. Ramona Nicolau-Raducu and Yehuda Raveh some of the characteristics that are unique about MTI.  

The program is housed within the massive Jackson Memorial Hospital, one of the ten largest hospitals in the world with 2000 beds.   Year in and out they are amongst the busiest abdominal programs with a US leading 472 kidneys transplanted in 2020, including a paired exchange program.  MTI is also a front-runner in liver for the last 50 years, with over 4500 cases performed and 131 adult and 22 pediatric in 2020.  Pancreas transplant is equally robust.  For more than 20 years, and greater than 500 cases, a multidisciplinary team of experts at MTI has been treating thousands of children and adults with intestinal failure via Intestinal Rehabilitation or the Intestinal/Multivisceral Transplant Program, with outcomes well above national averages.  Along with deceased donor intestinal (~5 cases/year) and multivisceral transplants (~10-15 cases/year), autologous transplant procedures are offered.  

MTI became in recent years a bloodless center for Jehovah Witness transplants with a meticulous selection process for Jehovah’s Witness liver candidates.  A bloodless protocol has been established of using factor concentrates, hemopure (bovine hemoglobin-based oxygen carrying solution) autotransfusion and cell saver.

In February 2020 the national organ allocation system transformed from donor service area-based to an acuity circles-based model. Due to its unique geography near the tip of the Florida peninsula, the new system limits organ allocation.  As a result, use of DCD and other extended criteria grafts for liver or liver-kidney have increased, currently approximately 25% of liver grafts. In addition, patients listed for multivisceral transplantation are especially impacted by this change.  Due to specific quality requirements for suitable donors, which are typically younger and non-obese, the available donor pool is considerably smaller. Previously these patients were assigned amongst the highest status levels on the liver match run, but the current allocation model routinely prioritizes a suitable donor to a liver alone candidate that does not have the same size and quality limitations but has a high “competitive” MELD score.

The Abdominal Transplant Anesthesia Fellowship at Jackson Memorial Hospital was created in 2006 by Dr. Ernesto Pretto, Chief, Division of Transplant Anesthesia and is one of the largest in the nation with 4 fellows/year.  Transplant anesthesiology fellowships are non-ACGME accredited and are generally less popular for board eligible/certified US anesthesiology graduates, however this program has thrived through selecting highly qualified foreign graduates to consistently fill its positions.   They have graduated a remarkable 50 transplant fellows in the last 15 years (10% US graduates and 90% International).

Many thanks to Drs. Nicolau-Raducu and Yahuda for sharing details of their program. 

If interested in having your program highlighted, please contact David Rosenfeld, Mayo Clinic Arizona at Rosenfeld.david@mayo.edu

 Featured Publications in the Transplant Literature: 

Michael Trostler, MD

Living donor liver transplantation for hepatocellular carcinoma beyond the Milan criteria: outcome of expanded criteria in tumor size (Liang et al. BMC Surg. 2021) 

Since 1996 Milan criteria for hepatocellular carcinoma has been used to guide liver transplantation to those who would benefit most and restrict deceased donor organs to those with the highest likelihood of survival. Living donor transplants tend to be directed to individuals who do not meet this criteria if the donor and recipient understand the potential risk. Liang et al. out of Taiwan report on 155 patients, 78 of which were beyond Milan criteria for tumor size or number found similar outcomes and recurrence rates. They propose a new criteria: maximum tumor size <= 6cm and total tumor size < 10cm.

Challenges and opportunities for treating intrahepatic cholangiocarcinoma (Serifis et al. Hepat Med. 2021)

There is potential to expand transplant criteria for living donor liver transplantation with less stringent criteria for directed donors. In addition to the potential for an expanded hepatocellular carcinoma guideline, cholangiocarcinoma is another disease process with historically poor outcomes which may be treated by transplantation with strict selection criteria, operative staging, and neoadjuvant therapy. 

Liver transplant outcomes after ex vivo machine perfusion: A meta-analysis (Liew et al. Br J Surg. 2021)

Ex-vivo machine perfusion – Meta-analysis included 34 articles with odds ratios favoring hypothermic machine perfusion over static cold storage. Findings include: decreased early graft dysfunction, ischemic cholangiopathy, non-anastamotic strictures and graft loss. Machine perfusion was associated with shorter length of stay. Normothermic perfusion is associated with reduced graft injury. 

Machine perfusion organ preservation: Highlights from the American Transplant Congress 2021 (Pavan-Guimaraes et al. Artif Organs. 2021)

At the American Transplant Congress (June 2021) 33 abstracts on machine perfusion were presented including heart, lung, liver and kidney. Machine perfusion may become gold standard in the future as innovation and advancement bring down costs and improve outcomes. 

SATA Committee’s Update

Yong G Peng, MD, PhD

We caught up with the Quality and Standards Committee Chair, Dr. Adrian Hendrickse (Associate Professor, University of Colorado). The members of the committee have been working hard on several surveys. The first survey, led by Dr. Cara Crouch (Assistant Professor, University of Colorado), looked at Adult Liver Transplant Anesthesiology practice patterns across the US. Their research was published in the Journal of Clinical Transplantation. (Crouch et al. Clin Transplant. 2021)

Additionally, a smaller sub-committee of members are interested in living donor liver transplantation (LDLT) status. The group, headed by Dr. Tetsuro Sakai (SATA president), has investigated LDLT programs across the US. They have submitted their findings in an abstract to the 2022 IARS/AUA and ILTS meetings. They plan to prepare a manuscript of their findings. The committee has worked closely with the Korean Society of Anesthesiologists in an effort to write a collaborative review of LDLT practice, which they are planning to submit to Clinical Transplantation. 

The Q&S committee members have worked on several other research projects, including similar survey-based methods, investigating different organ transplantation services, and pursuing the development of SATA endorsed guidelines for our subspecialty.

News clips from the Executive Board of SATA

Lorenzo De Marchi, MD, Secretary, SATA

The SATA council wishes its members a happy holiday and new year.  We are always looking for ways to ensure SATA meets your needs.  Send us your suggestions.  We are listening.  Let us update you on the most recent and exciting projects in the works.  

Membership renewal:  We look forward to working with you in the upcoming year so don’t forget to renew for 2022.  There is easy access on the website. New members will receive six months free SATA membership.  Let your colleagues know. 

The SATA-Data Collection Project; a collaborative data collection project that extends the American College of Surgeons NSQIP to  anesthesia outcome measures of abdominal transplantation.  Headed by Dieter Adelman an anesthesiologist from UCSF and Stuart Greenstein, a surgeon from Montefiore.  If your center wants to participate, please reach out to Dr. Dieter Adelman (dieter.adelmann@ucsf.edu) and Dr. Sher-Lu Pai (pai.sherlu@mayo.edu) for information.

New Professional Associations: SATA and the Society for Cardiovascular Anesthesia have agreed to work together on shared interests in both heart and lung transplantation.  We thank SATA President Dr. Ted Sakai and SATA Treasurer Dr. Jiapeng Huang, in addition to  Dr. Archer Martin from SCA for their hard work on this project.

New Committee:  SATA approves new Critical Care Medicine Committee.  Please contact Dr. Ranjiit Deshpande through the SATA home link to apply and find out more.

Expanding SATA research:  Go to the web to apply for the Society’s endorsement for your research project. Submit your application to the SATA Secretary (demarchilorenzo@yahoo.com) for Council review and feedback.

Mark the calendar and pack your flipflop and sunscreen!!

The SATA annual meeting at the IARS is in Hawaii on Monday, March 21th, 2022 as an in-person meeting.  If you can’t be there don’t forget about upcoming SATA regional meetings with CME credits.  Check on the Society’s website for a complete list and dates.

Explore Educational Content

Webinars

August 2021: Rise of the Machines in Solid Organ Transplant

February 2021: Pro/Con Debate: Routine Anticoagulation in Liver Transplantation 

October 2020: Pro/Con Debate: ECMO vs Cardiopulmonary Bypass in Lung Transplantation 

June 2020: Transplant Anesthesiology during the COVID-19 Pandemic 

Vanguard Expert Lecture Series

June 2021: Evaluation for Lung Transplantation: Pulmonologist Perspective 

March 2021: Living Donor Liver Transplantation: Donor Management 

 

Fellowship Lecture Series

August 2021: Cardiovascular Assessment of Liver Transplantation Candidates 

June 2021: Multivisceral Transplantation 

May 2021: Acute Liver Failure 

 

Transplant Anesthesia Upcoming Meetings

SATA Meetings 

SATA West Coast Liver Transplant Anesthesia Meeting, December 11, 2021 9am – 12:30pm PST – Register for the Virtual Meeting

SATA Midwest Meeting, January 22nd, 2022; 8:55 am – 12:30 PM CST – Register for the Virtual Meeting

SATA National Meeting at IARS, March 21, 2022, Honolulu, HI

SATA Tristate Meeting, April 9th, 2022

Other Transplant Anesthesia Meetings

ILTS Virtual Consensus Conference January 28-29, 2022

IARS Annual Meeting March 18 – 21, 2022, Honolulu, HI

ILTS Annual Meeting May 4 – 7, 2022, Istanbul, Turkey
 
Are you enjoying the SATA Newsletter? Please fill out a quick survey!

 
BOARD OF DIRECTORS: TERM  2021 – 2022

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

Yong G Peng MD, PhD

 

Newsletter Editorial Board

Sennaraj Balasubramanian, MD
Amit Bardia, MD
Jiapeng Huang, MD, PhD, FASA, FASE
M. Susan Mandell, MD, PhD
Sergio Navarrete, DO
David Rosenfeld, MD
Flora Simmons, MD
Natalie Smith, MD
Michael Trostler MS, MD

West SATA Conference 2021

By

SATA WEST COAST LIVER TRANSPLANT ANESTHESIA MEETING

SATURDAY, DECEMBER 11TH, 2021 09:00 AM – 13:20 PM – PST

Course Syllabus

Program overview:

This SATA regional meeting is a virtual meeting that has been designed to provide a broad spectrum of clinicians a review of the latest updates on a variety of intra-operative and critical care management topics in Liver Transplant Anesthesia.

 

Learning objectives:

1.      To understand the concept of transfusion free liver transplantation and its limitations.

2.      To understand the concept of Extended Criteria Donors (ECD) in liver transplantation, and the effect of using grafts from ECD on perioperative and postoperative outcomes. 

3.      Discuss liver transplantation in patients with COVID related acute liver failure.

4.      Review of current developments in liver transplant anesthesia fellowship training.

5.      To understand the potential for research and quality improvement using electronic medical data.

6.      To understand challenges of performing prospective clinical trials in liver transplantation.

7.      To review the perioperative management of liver transplant recipients with hyponatremia.

8.      To review the concept of simultaneous cardiac surgery (such as aortic valve replacement) and liver transplantation.

 

Target audience: 

Specialists working in organ transplantation (e.g., transplant anesthesiologists, intensivists, transplant surgeons, other transplant medicine specialists, and CRNAs) and trainees (e.g., residents, fellows; medical students, SRNAs, and nursing students).

 

Accreditation and CME credit designation: 

SATA – The Society for the Advancement of Transplant Anesthesia, University of Pittsburgh Medical Center

 

Organizing institutions and program committee members:

Kyota Fukazawa – University of Washington, Seattle, WA

Christine Nguyen-Buckley – University of California, Los Angeles, CA

Dieter Adelmann – University of California, San Francisco, CA

 

Platform:  Zoom – virtual Webinar

 

Registration:  Registration link to follow. There will be no registration fee.

             

Program:

9:00 am – 9:10 am Welcome & Introduction

Kyota Fukazawa – University of Washington

9:10 am – 10:00 am Clinical Challenges I

Moderator: Kyota Fukazawa – University of Washington
 
Transfusion Free Liver Transplant

Sherif H. Kandil – University of Southern California
 
Extended Criteria Donors in Liver Transplantation

David M. Rosenfeld – Mayo Clinic Arizona

10:00 am – 10:05 am Break

10:05 am – 11:00 am Current Concepts

Moderator: Andrea Olmos – University of California, San Francisco
 
Liver Transplantation for Acute Liver Failure in A Patient With COVID

Kristin Kidson and Jei Park – The University of British Columbia
 
Liver Transplant Anesthesia Fellowships

Christine Nguyen-Buckley – University of California, Los Angeles

11:00 am – 11:10 am Break

11:10 am – 11:15 am SATA Address

Tetsuro Sakai – President, SATA – University of Pittsburgh

11:15 am – 12:10 pm Research

Moderator: David M. Rosenfeld – Mayo Clinic Arizona
 
The Use of Electronic Medical Data for Research and Quality Improvement in Liver Transplantation.

Rishi P. Kothari – University of California, San Francisco
 
Prospective Clinical Trials in Liver Transplantation

Dieter Adelmann – University of California, San Francisco

12:10 pm – 12:15 pm Break

12:15 pm – 1:10 pm Clinical Challenges II

Moderator: Christine Nguyen-Buckley – University of California, Los Angeles
 
Management Of Hyponatremia During Liver Transplantation

Michael Lin – University of California, Los Angeles
 
Combined Cardiac Surgery & Liver Transplantation

Colby Tanner – University of California, Los Angeles

1:10 pm – 1:20 pm Closing Remarks

Kyota Fukazawa – University of Washington

 

NOTE:

In support of improving patient care, this activity has been planned and implemented by the UPMC and SATA. The University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME).  

Physician (CME)
The University of Pittsburgh Medical Center designates this live activity for a maximum of 4.5 AMA PRA Category 1 Credit ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclaimer Statement
The information presented at this CME program represents the views and opinions of the individual presenters. It does not constitute the opinion or endorsement of, or promotion by, the UPMC Center for Continuing Education in the Health Sciences, UPMC / University of Pittsburgh Medical Center or Affiliates and University of Pittsburgh School of Medicine.  Reasonable efforts have been taken intending for the educational subject matter to be presented in a balanced, unbiased fashion and compliance with regulatory requirements. However, each program attendee must always use his/her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions, including, without limitation, FDA-approved uses and any off-label uses.

 

Coagulation Current Understanding and Management: The Role of Point of Care TEG/ROTEM

By

SATA Fellow Lectures 2021-2022

Coagulation Current Understanding and Management: The Role of Point of Care TEG/ROTEM 

Aliaksei Pustavoitau, MD, MHS
Transplant Anesthesia Fellowship Program Director

Presenter: Aliaksei Pustavoitau, M.D.

Title: Associate Professor of Anesthesiology and Critical Care Medicine

Affiliation: Johns Hopkins School of Medicine

Date: 11/24/2021

Time: 05:00pm – 6:00am ET

Link:

https://miami.zoom.us/j/92597529210?pwd=MklCcWVXVHFSU0picDE0bnp3b2dDdz09

 

SATA South Regional Conference 2021

By

SATA SOUTH REGIONAL CONFERENCE

Members can watch the recorded South SATA Regional Meeting

This content is for SATA Members only

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Course Syllabus

Program overview:

The SATA South Regional Conference is a virtual meeting designed to provide a focused review of the latest updates on perioperative and critical care management for heart, lung, and liver transplantations. 

 

Learning objectives:

Upon completion of the CME activity, participants should be able to:

  1. Identify current practice on transfusion and circulatory support management during lung transplant surgery. Apply patient care strategies for patients with specific conditions, such as lung diseases caused by COVID-19 or systemic sclerosis.
  2. Review the most recent updates on heart transplant immunology and primary graft dysfunction. Debate the appropriateness of donor after cardiac death for heart transplantation.
  3. Implement patient care process for preoperative optimization, perioperative thrombosis management, intraoperative extracorporeal membrane oxygenation, and postoperative fast-track in liver transplantation. 

 

Target audience: 

Anesthesiologists, intensivists, surgeons, fellows, residents, medical students, nurse anesthetists, advanced practice nurses, anesthesiologist assistants, physician assistants, and nursing staff who are involved in the perioperative care of transplant patients. 

Accreditation and CME credit designation: 

SATA (The Society for the Advancement of Transplant Anesthesia), University of Pittsburgh Medical Center

 

Program committee: 

  • Chair: Sher-Lu Pai, MD (Mayo Clinic in Florida) 
  • Michael Little, MD (University of Texas Health Science Center at San Antonio)
  • Scott Lindberg, MD (Houston Methodist Hospital)
  • Marina Moguilevitch, MD (Montefiore Medical Center, Albert Einstein College of Medicine)

 

Program:

7:55 am – 8:00 am  Welcome 

Sher-Lu Pai, MD 

Education Coordinator, Transplant Anesthesia

Assistant Professor of Anesthesiology

Mayo Clinic in Florida

 

8:00 am – 9:40 am  Adult Lung Transplantation Session

Moderator: Christopher Y. Tanaka, MD, FASE

Program Director, Adult Cardiothoracic Anesthesiology Fellowship Assistant Professor of Anesthesiology 

Montefiore Medical Center

Albert Einstein College of Medicine

 

8:00 am – 8:20 am Updates in Lung Transplantation and Blood Transfusion

Brandi A. Bottiger, MD

Director, Adult Cardiothoracic Anesthesiology Fellowship

Associate Professor of Anesthesiology

Duke University 

 

8:20 am – 8:50 am  Pro/Con in the World of Lung Transplant:  Circulatory Support During Lung Transplant Surgery

Pro: David Langdon MD

Assistant Professor of Anesthesiology

UT Health San Antonio

Con: Major Matthew D. Read, MD, USAF

Assistant Professor 

Brooke Army Medical Center

 

8:50 am – 9:10 am Case from the Real World:  Lung Transplant for Respiratory Failure Secondary to COVID-19

Jacek Jablonski, MD

Assistant Professor

UT Health San Antonio

David Langdon, MD  

Assistant Professor

UT Health San Antonio

 

9:10 am – 9:30 am Case from the Real World: Lung Transplantation Anesthetic Considerations in Systemic Sclerosis

Ashley Fritz, DO

Assistant Professor

Mayo Clinic in Florida 

Archer Martin, MD

Chair, Division of Cardiovascular & Thoracic Anesthesia

Associate Professor

Mayo Clinic in Florida

 

9:30 am – 9:40 am Q & A

 

9:40 am – 9:50 am Break 

 

9:50 am – 10:10 am SATA Presidential Address 

Tetsuro Sakai, MD, PhD, MHA, FASA 

President, SATA

 

10:10 am – 11:20 am Adult Heart Transplantation Session 

Moderator: Ryan Craner, MD

Assistant Professor of Anesthesiology

Mayo Clinic in Arizona

 

10:10 am – 10:30 am Primary Graft Dysfunction After Orthotopic Heart Transplantation

Alina Nicoara, MD 

Associate Professor of Anesthesiology

Director, Perioperative TEE Services 

Duke University

 

10:30 am – 10:50 am Transplant Immunology for Anesthesiologists

Kumar Vivek, MD

Montefiore Medical Center

Assistant Professor of Anesthesiology

Albert Einstein College of Medicine

 

10:50 am – 11:10 am Case from the Real World: 

DCD Heart Transplant

Jason Adkins, MD

Assistant Professor of Anesthesiology 

Montefiore Medical Center

Albert Einstein College of Medicine

Lauren Lisann-Goldman, MD

Fellow, Adult Cardiothoracic Anesthesiology 

Montefiore Medical Center

Albert Einstein College of Medicine

 

11:10 am – 11:20 am Q & A

 

11:20 am – 11:30 am Break

 

11:30 am – 1:10 pm  Adult Liver Transplantation Session 

Moderator: Marina Gitman, MD

Cleveland Clinic

 

11:30 am – 11:50 am ECMO and Liver Transplantation

Ryan Chadha, MD

Division Chair, Multispecialty Anesthesia

Mayo Clinic in Florida

 

11:50 am – 12:20 pm Pro/Con Debates: Coagulation vs. Thrombosis Management in Liver Transplantation

Pro: Scott Lindberg, MD 

Director, Liver Transplant Anesthesia 

Houston Methodist Hospital

Con: Julius Balogh, MD

Medical Director, Cardiovascular Intensive Care Unit

Interim Division Chief, Anesthesia Critical Care 

University of Arkansas for Medical Sciences

 

12:20 pm – 12:40 pm Fast-Track in Liver Transplantation: It is more than Early Extubation

Stephen Aniskevich, MD

Chair, Division of Hepatobiliary and Abdominal Transplant Anesthesia

Mayo Clinic in Florida

 

12:40 pm – 1:00 pm Case from the Real World: Pre-Liver Transplant Management of Coronary Artery Disease

Jawad Rashid, MD

Transplant Anesthesia 

Houston Methodist Hospital

 

1:00 pm – 1:10 pm Q & A

 

1:10 pm – 1:15 pm Closing Remarks

Sher-Lu Pai, MD 

Education Coordinator, Transplant Anesthesia

Assistant Professor of Anesthesiology

Mayo Clinic in Florida

 

In support of improving patient care, this activity has been planned and implemented by the UPMC and SATA. The University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME). 

 

Physician (CME)

The University of Pittsburgh Medical Center designates this live activity for a maximum of 5.0 AMA PRA Category 1 Credit ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

Faculty Disclosure

  • Tetsuro Sakai, MD, PhD, MHA: Springer Inc. (Book royalty)

 

No other members of the planning committee, speakers, presenters, authors, content reviewers or anyone else in a position to control the content of this education activity have relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients to disclose.

 

Disclaimer Statement

The information presented at this CME program represents the views and opinions of the individual presenters. It does not constitute the opinion or endorsement of, or promotion by, the UPMC Center for Continuing Education in the Health Sciences, UPMC / University of Pittsburgh Medical Center or Affiliates and University of Pittsburgh School of Medicine.  Reasonable efforts have been taken intending for the educational subject matter to be presented in a balanced, unbiased fashion and compliance with regulatory requirements. However, each program attendee must always use his/her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions, including, without limitation, FDA-approved uses and any off-label uses.

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Rise of the Machines in Solid Organ Transplantation

By

PROGRAM

“Liver Machine Perfusion: A Primer for Anesthesiologists”

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Diethard Monbaliu, Associate Professor, University Hospital Leuven Belgium

Diethard MONBALIU (°Oostende, Belgium in 1971), MD, PhD currently works as an abdominal transplant surgeon at the University Hospitals Leuven, and is associate professor at the Catholic University Leuven, Leuven, Belgium (anatomy and clinical bioethics). His current research and scientific interest focuses on liver transplantation from donation after circulatory death donors, machine perfusion preservation, modulation of ischemia/reperfusion injury, peritoneal dialysis access and physical exercise after transplantation. He is a Senior Clinical researcher granted by the Research foundation Flanders (FWO) since 2015. He is the founder and chair of Transplantoux which raises awareness regarding organ donation, motivates transplant
recipients to exercise and live a healthy life. He is the founder and chair of the international Transplantoux symposium Time to move.

“DCD Heart Transplantation: Where Do We Stand?”
Peter Neuberger, Associate Professor, NYU

Peter Neuburger is an Associate Professor in the Department of Anesthesiology, Perioperative Care & Pain Medicine at the NYU Grossman School of Medicine, where he also serves as Director of Anesthesia for the Heart Valve Center. He is active in the ASA where he lectures on transplant anesthesiology, regional anesthesia and structural heart disease. He is Chair of the Bylaws Committee for the Society of Cardiovascular Anesthesiologists and a Fellow of the American Society of Echocardiography. Dr. Neuburger serves on the Editorial Board for the Journal of Cardiothoracic and Vascular Anesthesia and the Journal of Cardiac Surgery.

“ECMO in Liver Transplantation: Does It Work?”
Greg Serrao, Assistant Professor, Director of Mechanical Circulatory Support, Mount Sinai Medical Center

Dr. Gregory Serrao joined Mount Sinai Heart and the Zena and Michael A. Wiener Cardiovascular Institute full-time faculty on July 15th, 2019 in the role of Assistant Professor of Medicine and Director of Mechanical Circulatory Support for the Cardiac Cath Lab. He earned a Bachelor’s of Science in Engineering at The Cooper Union for Advancement in Science and Art and a Master’s of Science in Biomedical Engineering at Columbia University FU School of Engineering. He then completed medical school at Mount Sinai School of Medicine where he graduated with Distinction in Research for his work in cardiac tissue engineering. Dr. Serrao completed his internal medicine residency at Columbia University’s NY Presbyterian Hospital. He then completed general cardiology fellowship at Mount Sinai, where he served as chief fellow in his final year, and continued on to an interventional cardiology fellowship at Mount Sinai, where he also served as chief fellow.

 

“Lung Transplantation on ECMO”
Barbara Wilkey, Associate Professor, University of Colorado

Dr. Wilkey earned her Bachelor of Science in Nursing in 1995. She then went on to earn her Master of Science in Physician Assistant Studies in 1999 and then her Medical degree in 2008. All three degrees from her beloved Alma Mater, the University of Florida. Dr. Wilkey came to Colorado in 2008, first to Presbyterian St. Luke’s Hospital for a Transitional Internship and then to the University of Colorado for Anesthesiology Residency and Cardiothoracic Anesthesiology Fellowship. Dr. Wilkey is currently working he University of Colorado as an Attending Anesthesiologist specializing in lung, heart and liver transplantation.

 

 

 

 

“Intraoperative CRRT for Transplant in 2021”
Michael Lin, Assistant Professor, UCLA

Dr. Michael Lin completed a combined residency in Internal Medicine and Anesthesiology and a fellowship in Critical Care Medicine at Stanford Hospital. He joined the faculty at the University of California, Los Angeles, in 2018, where he works in both the surgical and cardiothoracic ICUs, as well as on the liver transplant anesthesiology teams. He serves as the Medical Co-Director for the Emergency Response Team at Ronald Reagan UCLA Hospital. His research interests include angiotensin II use in cirrhotic patients and long-term outcomes of intraoperative anesthesia practices during liver transplantation.

Fall 2021 Newsletter

By

New SATA Leadership Announced on August 1, 2021

Tetsuro Sakai, MD, PhD, MHA is the new President. The new SATA leaderships include Gebhard Wagener, MD (President-Elect: Columbia University), Lorenzo De Marchi, MD (Secretary: Georgetown University), and Jiapeng Huang, MD, PhD (Treasurer: University of Louisville), as well as Executive Councilors Ranjit Deshpande, MD (Yale University), Adrian Hendrickse, BM, FRCA (University of Colorado), Christine Nguyen-Buckley, MD (UCLA), and Ramona Nicolau-Raducu, MD, PhD (University of Miami). Dr. M. Susan Mandell serves as the Immediate Past President. Dr. Ernest Pretto, Jr. is the Founding President. 

 To see more join SATA.

Table of Contents

  1. New SATA Leadership Announced on August 1, 2021
  2. President’s Message: SATA – Ever Innovative, Inclusive, and Fiercely Active!
  3. Webinar: Rise of the Machines in Solid Organ Transplantation
  4. In the Transplant News:
  5. In the Spotlight: University of Virginia Medical Center
  6. Featured Publications in the Transplant Literature:
  7. SATA Committee’s Update
  8. Council Meeting Update
  9. Transplant Anesthesia Upcoming Meetings

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