SATA

Society for the Advancement of Transplant Anesthesia

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SATA Council Nominations – 2022

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Name with degree(s): Kyota Fukazawa, MD, PhD
Institution: University of Washington

Academic appointment: Professor

Departmental role:

Director of Transplant anesthesia,
Director of Transplant Anesthesia Fellowship Program

Specialty: Abdominal Transplant

Years of SATA membership: Founding member, member since 2012

Role(s) in SATA:

SATA West Coast Annual Regional Meeting: Senior Chair, 2018~
SATA Fellowship Committee 2020~
SATA Practice Management Working Group (SATA) 2022~
SATA Federation (International relation) Committee 2018~
SATA Abdominal transplant task force Committee 2018~
SATA Board of Directors 2016~
SATA Founding member 2012~

The reason for seeking the SATA Council position:

Having played a progressively more involved roll in SATA from joining in 2012 to being the senior chair of SATA west coast meeting this year, I am confident in taking the next step to expand my leadership skills. During serving multiple committees in my own institution, ILTS and SATA, I learned how important it is to listen. I want to be a listener to understand the issues of peers and work to put their ideas into action.

Name: Uzung Yoon M.D., M.P.H.

Institution: Sidney Kimmel Medical College
Thomas Jefferson University Hospital
111s 11th St G8290, Philadelphia, PA 19107
c: 215-910-0557, w: 215-955-6161
uzung.yoon@jefferson.edu

Academic appointment: Assistant Professor, Department of Anesthesiology

Departmental role: Co-Director, Liver transplantation Anesthesiology
Program Director, Liver Transplantation Anesthesiology Fellowship
Director, Anesthesia Coagulation Laboratory

SATA membership: 4 years

Role: Active member

Specialty: I am currently a liver transplantation anesthesiologist at Thomas Jefferson University
Hospital in Philadelphia.

The reason for seeking the SATA Council position:

The SATA has been invaluable in my growth and perspective as a transplant anesthesiologist. I attended numerous SATA meetings from New York down to Washington DC. I connected with colleagues, had intellectual discussions, and presented at recent meetings. I would like to become more actively involved in directly contributing to the organization. I also have seen SATA growing rapidly in the past few years and have big ambitions to promote SATA that more transplant anesthesiologist could benefit from the society.
From prior committee experience, I have learned that the most effective way to progress our field is through being active, and collaborating across institutions. Thank you for your consideration of my application. If any additional information is needed, I can be reached at the following email address: uzyoon@gmail.com or uzung.yoon@jefferson.edu.

Name with degree: Sathish S Kumar, MBBS

Institution: University of Michigan

Academic appointment: Associate Professor of Anesthesiology

Departmental role: Director of transplantation anesthesia

Specialty: Abdominal Transplant Anesthesia

Years of SATA membership: 3 years

Role(s) in SATA: committee’s on Q&S, Senor chair for Midwest regional meetings and organized past two meetings, Co-chair- TEE for abdominal transplantation, Committee on LDLT.

The reason for seeking the SATA Council position:

The reason for seeking the SATA Council position: I am passionate about clinical care of patients undergoing transplantation and my vision is to promote and enhance the care of solid organ transplantation including the care of living donor transplantation. My ongoing role with SATA in achieving this mission has been instrumental in getting younger generation of anesthesiologist involved in transplantation and work with SATA to further advance it. Given my role as a leader in my department, I strongly believe that I can contribute and help advance our society by being a member of the council. I look forward to that opportunity and working with a group of like minded individual to achieve that common goal. I feel I have a lot more to contribute to advance our society nationally and internationally to provide the best and safe clinical care of these patients. I look forward to working with SATA in advancing and promoting research in the area of transplantation.

Name: Raymond M. Planinsic, MD, FASA

Academic appointment: Professor of Anesthesiology

Departmental role: Chief of Transplantation Anesthesiology University of Pittsburgh Medical Center / Perioperative Medicine Director of Transplantation Anesthesiology Fellowship

Institution: University of Pittsburgh School of Medicine

Specialty: Abdominal Transplant Anesthesia

Years of SATA membership: Member of SATA since inception, one of it’s Founding Members

Roles in SATA:
Member Bylaws Committee, Member Fellowship Committee, Member SATA Practice
Management Working Group, Course Director of First SATA Review Course, Invited
speaker/panel member multiple SATA meetings

Reason for seating SATA Council position:

I am seeking appointment to the SATA Council at Large position to help continue to serve and improve SATA’s presence, role and influence in advancing the interests of its membership and the specialty of transplant anesthesia. SATA is in a unique position of educating the transplant field of the importance and role of transplant anesthesiologist. With continued involvement in the field, SATA can help set standards of practice, improve training of specialists, provide a forum/stage to voice the concerns of membership on how to improve patient care and increase the recognition of our field.

Name with degree: Adrian Hendrickse BM MMEd MAcadMEd FRCA

Institution: University of Colorado

Academic appointment: Associate Professor

Departmental role: Medical Director Abdominal Organ Transplant Anesthesia Team. Program Director Liver Transplant Anesthesiology Fellowship

Specialty: General Anesthesia, Regional Anesthesiology and Abdominal Organ Transplant Anesthesiology

Years of SATA membership: 5 years SATA membership

Roles in SATA: Chair of Quality and Standards Committee from 2019 to present Member of the Byelaws Committee from 2022

Reason for seating SATA Council position:

I believe that our society needs to offer a broader offering in education to its membership. I want to develop educational material that will engage new and interested learners in the field of transplant anesthesiology whilst harnessing the knowledge and experience of our existing members from across the country. Collaboration within our society should make this enterprise something worth pursuing and being a council member will enable me to leverage the support needed.

Update on Live Donor Liver Transplantation – Vanguard Lecture

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April Article of the Month 2022

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Outcome of Liver Transplants Using Donors After Cardiac Death with Normothermic Regional Perfusion.

Abstract:

Background and aims: The incorporation of normothermic regional perfusion (NRP) to donors after cardiac death (DCD) allows the recovery of liver grafts without the deleterious effects on graft survival the super-rapid technique may cause. The aim of the present report is to determine if the use of NRP in Maastricht type III DCD donors achieves short- and medium-term results comparable to donors after brain death (DBD).

Patients and methods: This is an observational cohort study including 117 liver transplants executed between November 2016 and April 2021, divided into NRP (n = 39) and DBD (n = 78).

Results: Donors were younger in the NRP group (NRP 52 vs DBD 59.4 years; P < .005). Liver recipients in each study group were of similar age and severity of liver disease, although the predominant transplant indication in the NRP group was hepatocellular carcinoma. No differences in ischemia times were found. The incidence of early allograft disfunction and primary nonfunction was balanced between NRP and DBD. Eight patients required retransplant, all of them in the DBD group. No differences were found in biliary complications (NRP 12% vs DBD 5%; P = .104). Ischemic cholangiopathy affected a single DBD patient. Graft survival’s Kaplan Meier curve shows a better outcome in the NRP group, although the difference did not reach significance (P = .075).

Conclusions: The incorporation of perfusion machines, and specifically the NPR in situ, converts suboptimal liver grafts such as DCD into organs comparable to DBDs.

Comments made by Cale Kassel M.D., FASA  

Summary:

In this observational cohort study the authors compared the use of normothermic regional perfusion (NRP) in donation after cardiac death (DCD) donors to donation after brain death donors (DBD). A total of 117 liver transplants were included, 39 in the NRP group and 78 in the DBD group.

Donors for the two groups were largely similar we a few exceptions. Donor age was lower in the NRP group (52 vs. 59.4; p = 0.005). While the number of days in the ICU was higher in the NRP group (7.21 vs. 2.62; p = 0.000), the use of vasopressor support was higher in the DBD group (86.4% compared to 35.1%). 

Recipient differences were similar for MELD scores for the NRP and DBD groups. (14.48 vs. 16.14; p = 0.392). The authors noted differences in indication for transplant between the two groups. For DBD, alcoholic cirrhosis was the most common indication followed by hepatocellular carcinoma. In the NRP group, hepatocellular carcinoma was the most common indication. 

No primary endpoint was noted but overall survival was similar between the two groups. One year survival for the NRP group as 94% compared to 84% in the DBD group and at three years, survival was 71% for the NRP group and 75% for the DBD group. While the Kaplan-Meier curve showed better survival with the NRP group, this did not reach statistical significance (p = 0.075). Biliary complications were not statistically different between the two groups (NRP at 12%, DBD at 5%). Early allograft dysfunction, primary non-function, and acute kidney injury were similar between the two groups. 

With constant need for donor organs, new ways to procure organs for transplant warrant consideration. Early evidence raised concerns on the rate of biliary complications with DCD donors that may limit their usefulness. However, NRP or machine perfusion appears to offer promise for DCD organ use while also minimizing biliary issues post-operatively. This small study adds to the body of evidence supporting the use of NRP for DCD organs. 

References:

Rodriguez RP, Perez BS, Daga JAP, et al. Outcome of Liver Transplants Using Donors After Cardiac Death with Normothermic Regional Perfusion. Transplantation proceedings 2022;54(1):37-40.

Spring 2022 Newsletter

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UNOS News

By Flora Simmons, MD

Liver transplant rates increase after implementation of new organ allocation policy

The OPTN data report is now available and describes key measures of the new liver and intestinal allocation policy for the 18-month period from February 2020 through August 2021.  Results show an overall  increase in deceased donor liver-alone and liver-kidney transplants, significantly increased transplant rate for sicker patients, and more transplants being performed between 250 and 500 nautical miles, leading to slightly longer median cold ischemic times. Read more here.  

 

Record setting year for heart, liver, and kidney transplants in 2021

For the first time, organ transplants in the United States exceeded 40,000 for a grand total of 41,354 organs transplanted in 2021. There were a total of 24,669 kidney transplants, 9,236 liver transplants, and 3,817 heart transplants. Heart transplants have set a new record for the past 10 consecutive years, while liver transplants have set annual records for the past nine years.  Read more here. 

 

DCD Procurement Collaborative Project surpassed goal and recovered DCD donors at a higher rate than the rest of the nation

Twenty-six OPOs from across the country collaborated with the aim to increase the number of DCD donor procurements. Improvement efforts were focused across multiple areas including strengthening relationships between donor hospitals and transplant programs and optimizing clinical practices. The cohort procured 34% more DCD donors in 2021 compared to 26% for the rest of the nation. Read more here.

 

New relationship with Corey & Associates (PACA) 

From Susan Mandell, MD and David Corey, MBA

SATA is excited to announce a new partnership with Corey & Associates (PACA) that will assist with the day-to-day business management of the society’s activities.  PACA has worked in the area of management and government relations since 1975, SATA looks forward to working with PACA in order to improve this membership experience.  Please find a link to PACA on our webpage here 

 

SATA and SCA Collaboration Update  

By Yong G. Peng, MD, PhD, FASE, FASA

 With the help of SATA treasurer Dr. Jiapeng Huang preliminary communication, SATA executive council members Drs. Tetsuro Sakai, Jiapeng Huang and Susan Mandell had a Zoom meeting with the Society of Cardiovascular Anesthesiologists (SCA) leadership group.  This was a productive discussion covering a wide range of potential collaborations between SCA and SATA. 

SCA’s president Dr. Andrew Shaw has fully endorsed Drs. Archer Martin of Mayo Clinic Jacksonville and Sharon McCartney of Duke to become the inaugural Co-Chairs for the Transplant Anesthesia Subcommittee of SCA.  Together they will oversee all the projects and progress of collaboration between SATA and SCA.   

The initial area of mutual interest will include the following: 

  1. SATA and SCA will exchange a formal Memorandum of Understanding (MOU) to make the collaboration official 
  2. Both organizations recognize the mutual interests including but not limited to: a) data-based research (heart and lung). b) practice guidelines  c) advocacy to UNOS 
  3. Both societies leaders also agreed on the importance of structured training and educational process for adult lung transplantation (ALT) anesthesiologists. They will work on the specific logistics to provide TEE training curriculum and competency assessment for ALT anesthesiologists 

In response to the call for SATA and SCA collaborations, both SATA’s CT Transplantation Committee and CT Educational Task Force Committee recently had a Zoom meeting to lay out the specific action plans.  The committees proposed that SATA has three cardiothoracic related entities (CT transplantation Committee, TEE Work Group and CT Educational Taskforce) working together to consolidate resources and make a collective effort to reach important goals. These include promoting cardiothoracic related missions of SATA to other societies scientific activities, distribution of cardiothoracic transplantation educational materials on the SATA website, hosting regular meetings on relevant cardiothoracic transplant topics to maintain SATA member’s interest, and keeping all three entities member engagement to advance SATA’s clinical and research interest in collaboration with other professional societies.

 

Research Updates and Interesting Articles

By Michael Trostler, MD

  1. OPTN/SRTR 2020 Annual Data Report Liver,  has been published.  This is the first official update from the start of the pandemic.  As of June 2020, 98,989 liver transplant recipients were alive.  The report is full of interesting information on total numbers, demographics, and outcomes.  Read more here
  • Does machine perfusion improve immediate and short-term outcomes by enhancing graft function and recipient recovery after liver transplantation? – A systematic review of the literature, meta-analysis and expert panel recommendations

Highlights: Hypothermic machine perfusion decreases post-reperfusion syndrome and early graft dysfunction.  Normothermic machine perfusion reduces incidence of post-reperfusion syndrome and early graft dysfunction.  Normothermic regional perfusion decreases likelihood of early graft dysfunction and risk of primary non-function.  Read more here

  • Sequential hypothermic and normothermic machine perfusion enables safe

transplantation of high-risk donor livers

Highlights:  Sequential Dual hypothermic oxygenated machine perfusion followed by Normothermic Machine Perfusion (DHOPE-NMP) was used to salvage 63% of originally discarded livers with 1 year graft survival 94%, and patient survival 100%.  Read more here

  • Liver resection versus liver transplantation for hepatocellular carcinoma within Milan criteria: a meta-analysis of 18,421 patients.

Highlights:  Mortality after liver resection is nearly 50% higher than liver transplant in hepatocellular carcinoma.  Read more here

Articles of the month from January and February, 2022

By Michael Ander, MD

  • Postreperfusion syndrome in liver transplantation: outcomes, predictors, and application for recipient selection

Highlights:  Donor age, donor BMI, moderate macrosteatosis, and CIT were identified as risk factors for the development of PRS in LT using DBD grafts. PRS risk evaluation may improve donor-to-recipient matching based on their MELD scores. Read more here

  • Is obesity associated with better liver transplant outcomes? A retrospective study of hospital length of stay and mortality following liver transplantation

Highlights:  Results provide evidence that overweight and obesity class 1 are associated with decreased length of stay and mortality following liver transplant, while underweight and obesity class 3 are associated with prolonged length of stay.  Read more here

 

In the Spotlight:  Houston Methodist Medical Center (Texas Medical Center)

By David Rosenfeld, MD, FASA

For this quarter’s segment we were able to connect with Scott Lindberg, MD, FASA, director of liver transplant anesthesiology at the 900 bed Houston Methodist Medical Center. 

Currently Methodist is one of the busiest abdominal programs in the US with 183 livers, 255 kidneys (47% live donor), and 14 pancreas cases completed in 2021. For the liver program nearly all are cadaveric, however they have launched a liver donor program with their first case in October 2021, and a second scheduled in early 2022.  Methodist is aggressive in utilizing advanced age/extended criteria grafts with over 20% DCD.  They are frequently using the Transmedic normothermic perfusion system and are working to publish their early experience.  Nearly all cases are on VV bypass, PA catheter and FloTrac are routine, TEE is placed in nearly 100% of cases with one team member advanced certified.  ABG assays are POC in-room. ROTEM is performed in the central lab; however, the tracing is visible in real time in the OR. Antifibrinolytics are given with documented hyperfibrinolysis in conjunction with on field coagulopathy, and in cases when greater than eight units of packed cells are administered.  A small percentage of patients are extubated in the operating room.    

The most unique aspect of the liver transplant anesthesiology practice is that it is covered exclusively with a dedicated six-physician team from the private practice group US Anesthesia Partners working either as the sole in-room provider or in conjunction with UT Houston anesthesia residents, who rotate late in the CA2 and throughout the CA3 years.  Team members carry faculty appointments at the Weill Cornell School of Medicine and/or Texas A&M College of Medicine.  This private staffing model is clearly uncommon, and particularly unusual given that the program was the third largest volume US center in 2021.  Several years ago, Methodist hired liver transplant anesthesiologist Randolph Steadman, MD, MS, to serve as Chair of Anesthesiology, to lead the hospital-based group, and to increase collaboration between the private and hospital practices. In that vein, in September 2021 the department was accredited for an anesthesiology residency, with Dr. Lindberg of US Anesthesia Partners in the role of program director. It is an exciting time as they recently matched their first class of six categorical residents to begin in July 2022. 

The transplant program has made it their mission to expand the donor pool by looking to technology and data to push the boundaries of extended criteria donors.  There is also a commitment to increase research activity with the establishment of the residency program.

 

Upcoming Meetings

SATA Meetings 

SATA Tristate Liver Anesthesiology  Meeting, NYU School of Medicine, April 9th, 2022; 9:00 am – 2:00  pm EST. Click here to Register Click here to review the Program Agenda

SATA Virtual Lung Transplant Anesthesia Fellowship Series, April 16, 2022 6:00 PM EST.  Dr. Jack Hanley will be interviewed by Dr. Brandi Bottiger exploring a surgeon’s perspective on lung transplantation.  Click here for advanced registration. here 

SATA East Regional Meeting, DMV Liver Transplant Anesthesia Meeting 2022.  Virtual, April 23rd, 2022 8:45am – 12:45 pm EST.  Click here for details here 

Other Meetings

ILTS Annual Meeting May 4 – 7, 2022, Istanbul, Turkey

American Transplant Congress June 4 – 8, 2022, Boston, MA

International Liver Transplant Congress June 22 – 26, 2022

ILTS Perioperative Care in Liver Transplant Meeting, October 21, 2022, New Orleans, LA

 

Opportunities

UTHealth Anesthesiology – Medical Co-Director of the Transplant Intensive Care Unit

The Department of Anesthesiology at McGovern Medical School at UTHealth is seeking applicants for the position of Medical Co-Director of the Transplant Intensive Care Unit (TSICU) at Memorial Hermann Hospital- Texas Medical Center.  

The role of the Medical Co-Director is to oversee and integrate all clinical policies and practice standards in close cooperation and collaboration with the Chief of Transplant Surgery, Pulmonary Critical Care Medicine and other collaborating services in the Transplant Service Line. The Medical Co-Director will partner with the Chair of the Department and the Division Chief of Critical Care Medicine to promote a cohesive strategy to enhance patient care, structure educational systems, standardize translational research opportunities and infrastructure where appropriate and promote a culture of clinical excellence.  Additionally, the Medical Co-Director will contribute to the transplant anesthesiology team and collaborate with hospital leadership including the Transplant Service line administrative and nursing teams.

Required qualifications:

  1.     MD/DO or equivalent with Board Certification in Anesthesiology
  2.     Title or experience commensurate with a rank of Assistant Professor or greater
  3.     Fellowship training in an ACGME Accredited Critical Care Medicine program
  4.     Additional fellowship training in transplant anesthesiology is preferred

If interested, please submit your CV and cover letter to:

George Williams, MD, FASA, FCCM, FCCP

Vice Chair for Critical Care Medicine, Department of Anesthesiology

McGovern Medical School at UTHealth

George.W.Williams@uth.tmc.edu

February 2022 – Article of the Month

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Is Obesity Associated with Better Liver Transplant Outcomes? A Retrospective Study of Hospital Length of Stay and Mortality Following Liver Transplantation. Anesthesia and Analgesia. 2022.

Abstract:

Background: The rise in obesity in the United States, along with improvements in antiviral therapies, has led to an increase in the number of obese patients receiving liver transplants. Currently, obesity is a relative contraindication for liver transplant, although exact body mass index (BMI) limits continue to be debated. Studies conflict regarding outcomes in obese patients, while some argue that BMI should not be used as an exclusion criterion at all. Therefore, this retrospective study-utilizing a large national database-seeks to elucidate the association between recipient BMI and hospital length of stay and mortality following liver transplant.

Methods: A retrospective study was conducted using the United Network for Organ Sharing Standard Transplant Analysis and Research database. Fine-Gray competing risk regressions were used to explore the association between BMI and rate of discharge, which varies inversely with length of stay. In our model, subdistribution hazard ratio (SHR) represented the relative change in discharge rate compared to normal BMI, with in-hospital death was considered as a competing event for live discharge. Cox proportional hazard models were built to assess the association of BMI category on all-cause mortality after liver transplantation. Cluster-robust standard errors were used in all analyses to construct confidence intervals.

Results: Within the final sample (n = 47,038), overweight (≥25 and <30 kg/m2) patients comprised the largest BMI group (34.7%). The competing risk regression model showed an association for increased length of stay among underweight (SHR = 0.82, 95% confidence interval [CI], 0.77-0.89; P < .001) and class 3 obesity patients (SHR = 0.88, 95% CI, 0.83-0.94; P < .001), while overweight (SHR = 1.05, 95% CI, 1.03-1.08; P < .001) and class 1 obesity (SHR = 1.04, 95% CI, 1.01-1.07; P = .01) were associated with decreased length of stay. When the sample excluded patients with low pretransplant functional status, however, length of stay was not significantly shorter for overweight and obesity class 1 patients. Cox proportional hazard models demonstrated increased survival among overweight, class 1 and class 2 obesity patients and decreased survival among underweight patients.

Conclusions: Our results provide evidence that overweight and obesity class 1 are associated with decreased length of stay and mortality following liver transplant, while underweight and obesity class 3 are associated with prolonged length of stay. Pretransplant functional status may contribute to outcomes for overweight and class 1 obese patients, which necessitates continued investigation of the isolated impact of BMI in those who have had a liver transplant.

Comments made by Cale Kassel M.D., FASA  

Summary:

In this retrospective study1 examining obesity in liver transplant patients, the authors utilized data from the Scientific Registry of Transplant Recipients (SRTR) to compare obesity class and hospital length of stay (LOS) and mortality. With nonalcoholic steatohepatitis (NASH) set to become the leading indication for LT, providers must consider the risks of transplantation in obese patients. With conflicting data on the risk of obesity in LT, this is usually a center-specific guideline on listing patients with elevated BMI. A total of 47,038 patients were reviewed and divided into 6 groups (underweight, normal, overweight, obese I, obese II, and obese III).

Compared to normal weight patients, hospital LOS was lower in the overweight and class I obesity group while it was longer in the obese III and underweight groups. Further risk analysis that excluded patients with hospitalization prior to transplant, functional status < 50%, mechanical ventilation still demonstrated longer LOS with underweight and obese III groups.

At 90 days, survival was lowest in the underweight and class III obesity group of patients (95.5%, 94.1% respectively). Survival at 1 year and 10 years were lowest in the underweight group of all groups studied. Interestingly, the class I obesity group had the best 1-year and overall survival by the unadjusted Kaplan-Meier model.

The retrospective nature of the study and the presence of ascites are both limitations interpreting the data. Factoring in ascites in the body weight calculation can be challenging and may have led to overrepresentation of obese patients in this study.

Ultimately, the authors found shorter LOS in overweight and class I obesity. Both underweight and class III obesity had longer LOS. Further research into this topic is needed to evaluate the role of functional status in obesity and outcomes. For programs looking to identify specific cutoffs, the authors suggest, based on their findings, that many centers may benefit from a BMI cutoff of > 40 kg/m2.  It should be noted that both the AASLD and AST consider class III obesity as a contraindication for LT. The EASL suggests careful evaluation of patients with a BMI > 35 kg/m2.

References:

  1. Du AL, Danforth DJ, Waterman RS, Gabriel RA. Is Obesity Associated with Better Liver Transplant Outcomes? A Retrospective Study of Hospital Length of Stay and Mortality Following Liver Transplantation. Anesthesia and Analgesia. 2022.

January 2022 – Article of the Month

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Postreperfusion syndrome in liver transplantation: Outcomes, predictors, and application for recipient selection. Clinical Transplantation. 2022.

“Background: This study aimed to identify risk factors for postreperfusion syndrome (PRS) and its impact on LT outcomes.

Methods: Data analysis was performed in 1021 adult patients undergoing donation after brain death (DBD) LT to identify PRS incidence, the risk factors for PRS development, and its impact on LT outcomes.

Results: The overall incidence of PRS was 16.1%. Independent risk factors for PRS included donor age (odds ratio (OR) 1.01, P = .02), donor body mass index (BMI) (OR 1.04, P = .003), moderate macrosteatosis (OR 2.48, P = .02), and cold ischemia time (CIT) (OR 1.06, P = .02). On multivariable analysis for 30-day graft failure, PRS (hazard ratio (HR) 3.49; P < .001) and Model for End-stage Liver Disease (MELD) score (HR 1.01; P = .05) were independent risk factors. Patients were categorized into four distinct groups based on PRS risk groups and MELD groups, which showed different 1-year graft survival (P < .001). There were comparable outcomes between low PRS risk – high MELD and high PRS risk – low MELD group (P = .33).

Conclusions: Donor age, donor BMI, moderate macrosteatosis, and CIT were identified as risk factors for the development of PRS in LT using DBD grafts. PRS risk evaluation may improve donor-to-recipient matching based on their MELD scores.”

Comments made by Cara Crouch, MD  

This article conducted a retrospective review of all adult DBD liver transplants from a single center over a 15-year period, excluding patients who received multi-organ transplants, DCD grafts, split grafts, LDLT, retransplant and patients who were transplanted due to acute liver failure, to identify risk factors for the development of postreperfusion syndrome (PRS). The authors also reviewed outcomes and offer suggestions for donor/recipient matching to reduce the incidence of PRS. The authors defined PRS as “a >30% decline in mean arterial pressure (MAP) from baseline within 5 minutes of graft reperfusion and lasting at least 1 minute.” A total of 1021 cases were reviewed and the overall incidence of PRS was found to be 16.1%.

The authors found no recipient factors that were statistically significant for an association with PRS. Four donor factors were found to be independently associated with PRS: donor age, donor BMI, moderate macrosteatosis (30-60%) and cold ischemia time. The authors used this data to develop a PRS risk sore used to categorize patients as either low or high PRS risk.

Patients also underwent further risk stratification, low ( 25) vs. high (>25) MELD, in combination with low vs. high PRS risk to analyze graft and patient survival. The occurrence of PRS was found to be associated with worse short-term graft and patient outcomes but not long-term outcomes. When PRS risk and MELD score were combined, it was found that patients with high MELD and high PRS risk factors had poor outcomes. The authors suggest that identifying the PRS risk factors and utilizing the risk score may allow for more optimal donor/recipient matching to improve overall outcomes.

References:

1. Bekki Y, Myers B, Wang R, Smith N, Zerillo J, Rocha C, Tabrizian P, Moon J, Arvelakis A, Facciuto M, DeMaria S, Florman S. Postreperfusion syndrome in liver transplantation: Outcomes, predictors and application for recipient selection. Clinical Transplantation. 2022.

International consensus recommendations for anesthetic and intensive care management of lung transplantation

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“International consensus recommendations for anesthetic and intensive care management of lung transplantation. An EACTAIC, SCA, ISHLT, ESOT, ESTS, and AST approved document.”

Nandor Marczin, MD, PhD, Eric E.C. de Waal, MD, PhD, Peter M.A. Hopkins, MD, Michael S. Mulligan, MD, Andre Simon, MD, PhD, Andrew D. Shaw, MB, FRCA, FRCPC, FFICM, Dirk Van Raemdonck, MD, PhD, Arne Neyrinck, MD, PhD, Cynthia J. Gries, MD, MS, Lars Algotsson, MD, PhD, Laszlo Szegedi, MD, PhD, and Vera von Dossow, MD, Task force Chairs and Writing Group (exclusive of the consensus developing and coordinating group members): Aidan Burrell, MBBS, PhD; Paula Carmona, MD, PhD; Donna Greenhalgh, MB, ChB, FRCA; Dominik Hochter, MD; Bessie Kachulis, MD; Christopher S. King, MD; Marc J. Licker, MD; David R. McIlroy, MBBS, MClinEpi, MD, FANZCA; Priya Nair, MBBS, MD, FCICM, PhD; Daniela Pasero, MD, MSc; David Pilcher, MBBS, MRCP, FCICM, FRACP; Steffen Rex, MD, PhD; David Royston, FRCA; Peter Slinger, MD, FRCPC; Franco Valenza, MD; Chris Walker, MBBS, FRCA, FFPMRCA, FFICM. Consensus members (exclusive of the consensus developing and coordinating group or co-chairs and writing group members): Antonio Arcadipane, MD; Oliver Bastien, MD, PhD; Joseph A. Bekkers, MD, PhD; Dominique Bettex, MD; Francesca Caliandro, MD; Erika Dal Checco, MD; Robert Duane Davis, MD; Goran Dellg- ren, MD, PhD; Andreas Espinoza, MD, PhD; Marie Louise Felten, MD; Paolo Feltracco, MD; Marc Fischler, MD; Linda J Fitzgerald, PharmD, BCPS; Ana Flo Forner, MD; Isabel Fragata, MD; Ana Gonzalez Roman, MD, PhD, MBA; Paul Harris, MBChB, FRCA, FFICM, RCPathME; Matthias Hommel, MD, MBA; Nicholas J. Lees, FRCA, EDIC, FFICM; Morgan Le Guen, MD, PhD; Marc Leone, MD, PhD; Thierry Lepoivre, MD; Carlo Marcucci, MD; Sabina Martelli, MD; Mir- eille Michel-Cherqui, MD; Ulrich Molitoris, MD; Philippe Montravers, MD, PhD; Roberto Mosca, MD; Barbora Parizkova, MD, FRCA; Mahesh Prabhu, MD, FRCA, FFICM; Francesco Pugliese, MD; Sanjeev M. Raman, MBBS, MD; Cristina Ramos, MD; Vito Marco Ranieri, MD; Maria I. Real, MD, PhD; Sven-Erik Ricks- ten; Ana Gonzalez Roman, MD, PhD, MBA; Bertrand Rozec, MD, PhD; Shiva M. Sale, MBBS, MD, FASE; Juan F. Sanchez, MD, FCCP; Johanna Schwarzenberger, MD; Sema Turan, MD; Kamen Valchanov, BSc, MD, FRCA, FFICM; Vincent G. Valentine MD, FCCP; Peter von Homeyer, MD, FASE; Alain Vuylsteke, BSc, MA, MD, (FRCA, FFICM); Thomas Weig, MD; Iratxe Zarragoikoetxea, MD, PhD; Sebastian Zenz, MD. Independent Reviewers: Pierre-Emmanuel Falcoz MD; Ilhan Inci, FEBTS; Andrew Roscoe, FRCA; Mert Senturk, MD.
J Heart Lung Transplant 2021 Nov;40(11):1327-1348.

This quarter’s editorial is taking a step off the beaten path. Last month the Journal of Heart and Lung Transplantation published, what I believe to be, a groundbreaking international multidisciplinary document for perioperative care of lung transplant recipients. This document acknowledges that anesthetic and intensive care management impacts long term outcomes in lung transplant recipients. It offers a combination of published data and expert opinion for guidance and is the first major consensus document to specifically address anesthetic care for lung transplantation.

Key themes include the inclusion of anesthesiologists and intensivists in the selection of lung transplant recipients, use of echocardiography intraoperatively, indications for intraoperative rescue mechanical support, timing of ECMO wean, and strategies for the prevention of primary graft dysfunction. This is a strong document. I hope you give it a read.

Barbara Wilkey, MD

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.