Winter 2023 SATA Newsletter
By Flora Simmons, MD
UNOS Launches National Liver Pairing Program
In an effort to increase access to living donations, UNOS has initiated a national pairing program for swapping livers. While some transplant centers have swapped livers within their own hospitals, this program now allows swapping across the nation.
Waiting Time Adjustment Approved For Kidney Transplant Candidates Affected By Race-based Calculation
After discontinuing race-based calculations for estimated glomerular filtration rate (eGFR), the new policy will now allow African-American kidney transplant candidates to receive waiting time modifications that will increase their waiting times and associated prioritization for transplant.
National Collaboration To Increase DCD Lung Transplantation Underway
UNOS recently launched a national initiative to identify and share effective practices that can increase transplantation of DCD lungs. Twenty-nine lung transplant programs are participating in this project.
Research Updates and Interesting Articles
By Michael Trostler, MD
- Validation of the Liver Transplant Risk Score in Europe
LTRS is a useful predictor of Mortality that has been validated in the United States, but not in Europe. Based on the data the European registry collects, the score has been modified to exclude Diabetes. Age, BMI, MELD score, and Dialysis status were used with linear correlation for 90-day and 1-year mortality for each point. Included 2nd article external validation of LTRS in US (2020).
Validation of the Liver Transplant Risk Score in Europe.pdf
Preoperative Stratification of Liver Transplant Recipients- Validation of LTRS.pdf
- Anesthesia Management of a Liver Transplant Recipient with Remimazolam
Case report of a 54 year old Female who had a prolonged living donor liver transplant (1037 min) and massive blood loss (22.5L) who was successfully managed with Remimazolam without recall or adverse events with EEG monitoring.
Anesthesia Management of a Liver Transplant Recipient with Remimazolam.pdf
- Survival Benefit of Living-Donor Liver Transplant
Large epidemiological study on 119,275 Liver transplant patients, with 2,820 living donor transplants which found a 13-17 year life gain for those who received a liver donor transplant for MELD>11, compared to those who stayed on the waiting list. This article generated significant interest with several comments/letters and the original authors reply which are well worth your time to read.
Survival Benefit of Living Donor Liver Transplant.pdf
Reply to Survival Benefit of Living Donor Liver Transplant 1.pdf
Reply to Survival Benefit of Living Donor Liver Transplant 2.pdf
Reply to Survival Benefit of Living Donor Liver Transplant 3.pdf.
- Mortality scoring systems for liver transplant recipients: before and after model for end-stage liver disease score
An updated review article of end stage liver disease scoring systems and their inherent weaknesses. The future may be artificial intelligence, but its predictive algorithms can be individualized and may not be applicable to the wider population outside of each study cohort.
Mortality scoring systems for liver transplant recipients- before and after model for end stage liver disease score.pdf
- Comprehensive quality initiative leads to immediate postoperative extubation following liver transplant
A concerted push via QA/QI project achieves safety and success for immediate extubation of liver transplant recipients in both low risk and high risk patients. There was no change in mortality and only four(1.26%) patients were reintubated within 24 hours (Total 317 patients). Quality initiative pushes immediate extubations from 13.4% to 86.7% over a five year period.
Comprehensive Quality initiative leads to immediate postoperative extubation following liver transplant.pdf
By Alex Stoker, MD
IVC stenosis during liver transplant detected with TEE
Acute inferior vena cava (IVC) stenosis after liver transplantation is a rare but significant complication that can result in liver allograft congestion and dysfunction as well as hemodynamic instability. Transesophageal echocardiography (TEE) may be used to diagnose IVC stenosis, which may reveal a high velocity or turbulent jet entering the right atrium from the IVC as detected with color flow Doppler (CFD) (see figure below). By interrogating the IVC, it may be possible to visualize the area of narrowing within the IVC, with CFD revealing flow acceleration and turbulent flow originating at the level of stenosis. Obstruction may occur in the suprahepatic IVC, infrahepatic IVC or hepatic veins and can be due to surgical complication or due to thrombosis. There is increasing use of TEE to evaluate hepatic and IVC vasculature during liver transplantation (Khurmi et al, 2019). Reference
Midesophageal bicaval view with color compare showing the image both with and without color flow Doppler. A turbulent and high velocity jet is seen entering the right atrium from the IVC due to IVC stenosis. LA, left atrium; RA, right atrium; IVC, inferior vena cava; SVC, superior vena cava.
2022 UNOS Organ Transplant Summary
By Alexandra Ruan, MD
- More than 42,800 organ transplants performed in 2022, a 3.7% increase from 2021
- Total kidney transplants exceeded 25,000 for the first year ever
- Annual records also set for liver (9,528), heart (4,111) and lung (2,692) transplants
- Over 6,400 living donor transplants
- Deceased donation increased for 12th consecutive year
- The U.S. has now performed over 1 million transplants
In the Spotlight: Virginia Commonwealth University (VCU) Health System – Hume/Lee Transplant Center
By David Rosenfeld, MD, FASA
For this winter’s section we reached out to Spencer Liebman, MD, who is Chief, Division of Transplant Anesthesiology at VCU. Formerly known as Medical College of Virginia, VCU is an 820 bed health system and one of the nation’s first transplant programs. This historic program is named for David M. Hume, MD and Hyung Mo Lee, MD, and is where one of the earliest identical twin kidney transplants was performed in 1957, with the overall program starting in 1962. Soon after livers began in 1964, with the world’s 16th heart transplant in 1968. The scope of organs includes livers, kidneys, pancreas, and hearts, with experience in combined heart-liver transplant. A total of 502 organs were transplanted in 2022.
VCU offers 112 ICU beds, 16 of which are cardiac, and a dedicated transplant ICU growing to 10 beds under the direction of Megan Rashid, MD. The liver practice is large with 168 total adult organs, 21 of which were from living donors. Staffing is in a team care model with five dedicated attendings, six specially trained CRNAs, and residents rotating in their CA2/CA3 years. TEG is universal, and TEE is utilized for greater than 80% of cases. As is becoming more common, intraoperative hemodialysis (not CRRT) was used in 40% of cases in 2022. They offer a unique Active Severe Alcoholic Hepatitis Transplant Program with support services and strategies in place. VCU has a non-ACGME liver fellowship with a hybrid model of combined fellow and faculty time and two positions per year. In 2016 the Total Pancreatectomy with Islet Cell Autotransplant (TPIAT) program was started with the addition of Transplant Surgeon Marlon Levy, MD to the faculty. A total of 18 TPIATs were performed in 2022 for chronic pancreatitis, and they are one of the few centers offering this experimental therapy. Their cardiac program is the longest running on the east coast and the second oldest in the US. Over 680 heart transplants have been performed, and they offer an ACGME accredited Adult Cardiothoracic Anesthesiology fellowship with two fellows per year. There are no lung transplants being performed at present.
Many thanks to Dr. Liebman for sharing details of the transplantation program at VCU. If interested in having your program highlighted in the future, please contact David Rosenfeld, Mayo Clinic Arizona at Rosenfeld.firstname.lastname@example.org
*The original newsletter identified VCU as performing the first identical twin kidney transplant in 1957. This was in error, the first kidney transplant was performed in an identical twin by Dr Joseph E.Murray in Boston in 1954. Correction made above.
Report from the Executive Council
By Susan Mandell, MD
We look forward to seeing SATA members at the in person SATA National Meeting, held at the IARS on April 17th, 2023, in Denver Colorado. Please remember to renew your membership for free entry to the meeting. SATA is pleased to announce it will hold the first combined meeting with the International Liver Transplant Society-SATA meeting just prior to the ASA in San Francisco. This has been a very popular meeting and well attended.
The Council is pleased to announce that there are now seven regional SATA meetings. Please check for the meeting closest to you. Service on the SATA Accessibility and Diversity Committee is now open to all members. The Vanguard committee has been revitalized and membership is open to all faculty who are within 5 years of residency completion or are younger than 42, please reach out to the SATA Office for more information.
We are pleased to announce that SATA will be represented at the 10th Annual Korean Society of Transplant Anesthesiologists (KSTA) meeting in Seoul, Korea. During the Joint KSTA-SATA session (March 18, 2023 11:20-12:50 KST), moderated by Dr. Tetsuro Sakai and Justin Sangwook Ko, Dr. Satish Kumar will present on emerging evidence for coronary artery disease screening in liver transplant candidates and Dr. Ramona Nicolau-Raducu will present on post-reperfusion hyperfibrinolysis.
SATA is delighted to endorse the first International Symposium for Abdominal Organ Transplant (ISAOT) in Santiago, Chile, June 8-9, 2023.
This opportunity is presented by Dr. Klaus Torp at Mayo Clinic-Jacksonville (Founding member of SATA) who has supported the physician exchange program with the Clinica Alemanha in Santiago de Chile. Dr. Lucile Gignon (Faculty Anesthesiologist at the Clinica Alemanha in Santiago de Chile) is the local organizer of the meeting.
Attention liver transplant anesthesiologists and program directors! SATA is offering free 6 month membership to fellows! Please sign up by emailing email@example.com. We look forward to welcoming new fellow members!
Join the Vanguard Committee ***
Transplant Anesthesia Upcoming Meetings
SATA Tristate Regional Meeting – in person and virtual
March 25th, 2023, New York, NY
April 17th, 2023, Denver, CO
The 10th annual scientific meeting of the Korean Society of Transplantation Anesthesiologists (KSTA), March 18th, Seoul, Korea – in person and hybrid
Joint KSTA-SATA Session: 11:20 – 12:50 KST
IARS/AUA/SOCCA Annual Meeting – in person and hybrid
April 13-16th, 2023, Denver, CO
The 2023 International Congress of ILTS, ELITA and LICAGE
May 3-6, 2023; Rotterdam, Netherlands
American Transplant Congress (ATC) 2023 Annual Meeting
June 3-7, 2023, San Diego, CA
International Symposium for Abdominal Organ Transplant (ISAOT)
June 8-9, 2023, Santiago, Chile
Tristate Regional Transplant Anesthesiology Conference 2023
Learning objectives – On completion of this activity the participants will be able to
- Learn about the concept of frailty and its importance in evaluation/management and outcomes for abdominal transplant recipients
- Discuss indications and practical considerations for use of veno-venous bypass in liver transplantation and advanced hepatobiliary surgery
- Review strategies for prevention and treatment of acute kidney injury in liver transplantation
- Learn about strategies to improve graft quality in donation after circulatory determination of death in organ transplantation, including machine perfusion
- Review ethical and practical considerations in organ donation after circulatory determination of death
- Discuss administrative considerations in managing a transplant anesthesiology service line and fellowship
Transplant anesthesiologists, intensivists, transplant surgeons, residents, and fellows.
Time and Location:
SATURDAY, MARCH 25TH, 2023: 9 AM – 2 PM, WEILL CORNELL MEDICINE
1300 YORK AVENUE, NEW YORK, NY 10065 WEILL AUDITORIUM (C-200)
Meeting ID: 977 5076 1082
9:00 – 9:30: Breakfast and Welcome: Christine Lennon M.D., Weill Cornell Medicine
9:30 – 10:30: Perioperative considerations
Frailty in abdominal transplant – Joseph Scarpa, M.D. and Rohan Panchamia M.D., Weill Cornell Medicine
Veno-venous bypass in liver transplantation – Juan Rocca M.D., Weill Cornell Medicine
ICU Management: postoperative acute kidney injury in liver transplantation – Christopher Tam M.D., Montefiore Medical Center
10:30 – 10:45: Break
10:45 – 11:30: Donor considerations
DCD donation and NRP – Zeeshan Akhtar M.D., The Mount Sinai Hospital
DCD practical and ethical considerations – Christine Lennon M.D., Weill Cornell Medicine
11:30 – 12:15: Lunch
12:15 – 1:15: Administrative considerations
Anesthesiologist as the perioperative physician: the transplant anesthesiology model – Nikhil Chawla M.D., Yale New Haven Hospital
Transplant anesthesiology service considerations – Joseph Yeh M.D., NYU Langone Health
Transplant anesthesiology fellowship considerations – Natalie Smith M.D., The Mount Sinai Hospital
1:15 – 1:45: Keynote address: Tetsuro Sakai M.D., University of Pittsburgh Medical Center
1:45 – 2:00 Closing Remarks: Gebhard Wagener M.D., Columbia University Irving Medical Center
Registration Fees and Link:
Complimentary Registration if no CME credits are required
$30.00 for SATA and SCA Members – CME Credits Needed
$60.00 for Non-SATA and SCA Members – CME Credits Needed
Organizing committee members (alphabetical):
- Ranjit Deshpande, MD, FCCM (Yale New Haven Hospital, New Haven, CT)
- Christine Lennon, MD (Weill Cornell Medicine, New York, NY)
- Marina Moguilevitch, MD (Montefiore Medical Center, Bronx, NY)
- Natalie Smith, MD (The Mount Sinai Hospital, New York, NY)
- Gebhard Wagener, MD (Columbia University Irving Medical Center, New York, NY)
- Joseph Yeh, (NYU Langone Health, New York, NY)
Directions to Weill Auditorium (C-200)
Enter the medical school at 1300 York Avenue.
After you go through security, proceed to the second floor via the stairs or elevator.
As you exit the staircase, make a left and walk down the hall. C-200 will be on the right.
The 2023 Symposium of the Society for the Advancement of Transplant Anesthesia
In conjunction with the annual meeting of the International Anesthesia Research Society (IARS)
Note: SATA Council meeting on April 16
Monday April 17, 2023 (8 AM – 3:00 PM)
Location: Mineral A-C room on Level 3, Hyatt Regency Denver at Colorado Convention Center, 650 15th Street, Denver, CO 80202
Registration (with CME credit):
https://sata2022.wufoo.com/forms/z1e9i2pz1p5x4o8/ or https://tinyurl.com/mr2rn9ks
$50 for SATA, SOCCA and SCA members, $150 for non-members, free for trainees
7:30 am – 8:00 am Registration
8:00 am – 8:15 am Welcome and Introduction
- Gebhard Wagener, President-elect – Columbia University, New York, NY
8:15 am – 9:15 am: Session 1: The Yin and Yang of coagulation (60 min)
Moderator: Alexandra Ruan – Stanford University, Stanford, CA
- New models and new drugs in coagulation (20-25 min)
- Art Bracey – Baylor College of Medicine
- Anticoagulants and surgery: Stop, continue, reverse?
- Abdominal transplant (10 min)
- Manoj Iyer – The Ohio State University Wexner Medical Center
- Thoracic transplant (SCA) (10 min)
- Kenichi Tanaka – The University of Oklahoma College of Medicine
- Abdominal transplant (10 min)
9:15 am – 9:45 am: Coagulation debate (30 min)
- Are ROTEM and Cryoprecipitate dangerous for liver transplants? (10 min)
- Christine Nguyen-Buckley – University of California Los Angeles
- Are PCC and Vit K dangerous for heart transplants? (10 min)
- Jiapeng Huang – University of Louisville, Kentucky
9:45 am – 10:30 am: Session 2: Pain and analgesia for transplant surgeries (45 min)
- Regional techniques for thoracic transplants and VADs (10 min)
- Anis Dizdarevic – Columbia University, New York, NY
- Indications and challenges to early extubation in the operating room (10 min)
- Courtney Scott – Mayo Clinic Jacksonville, FL
- Analgesia for living liver donors (KSA) (15 min)
- Justin Ko – Sungkyunkwan University School of Medicine, Samsung Medical Center; Director of Scientific Affairs, Korean Society of Anesthesiologists – Seoul, Korea
10:30 am – 11:00 am: Break
11:00 am – 11:20 am State of the Society
- Ted Sakai, President of SATA – University of Pittsburgh Medical Center, PA
- (Introduction: Susan Mandell – McGovern Medical Center, Houston TX
11:20 am – 12:00 pm Case presentations
Moderator: Adrian Hendrickse – University of Colorado Denver, CO
- Thoracic Transplant
- Michelle Chen- Columbia University, New York, NY
- Mentor: Andrea Miltiades – Columbia University, New York, NY
- Abdominal transplant
- Zach Fleissner – Mayo Clinic Jacksonville, FL
- Mentor: Ryan Chadha – Mayo Clinic Jacksonville, FL
12:00 pm – 1:00 pm Session: What’s new in organ donation and allocation (60 min)
- How is transplantation organized: past and future of UNOS and organ transplantation in the US (15-20 min)
- Jennifer Prinz – CEO of Donor Alliance and Vice Chair of the OPTN Policy Committee
- The impact of the new regulation of organ allocation on transplant practices (15-20 min)
- Jim Pompeselli – University of Colorado Denver, CO
- Deceased donor management and machine perfusion modalities (15 min)
- Emily Vail – University of Pennsylvania, Philadelphia, PA
1:00 pm – 1:30 pm Break
1:30 pm – 2:30 Session: How and why do we maintain blood pressure and perfusion (45 min)
Moderator: Ana Fernandez-Bustamante – University of Colorado Denver, CO
- Just a bystander organ? How do we protect the kidney? (15 min)
- HT Lee – Columbia University, New York, NY
- New kids on the block
- Angiotensin (10 min)
- Michael Bokoch – University of California San Francisco, CA
- Terlipressin (in collaboration with the Society of Critical Care Anesthesiologist, SOCCA) (10 min)
- Sathish Kumar, University of Michigan, Ann Arbor, MI
- Angiotensin (10 min)
2:30 pm – 2:45 pm First SATA Research Award
- SATA Research Committee
- She- Lu Pai – Mayo Clinic Jacksonville, FL
- Dieter Adelmann – University of California San Francisco, CA
2:45 pm – 3:00 pm Closing Remarks
- Lorenzo De Marchi, SATA Secretary – MedStar Georgetown University Hospital
SATA Seed Funding
SATA Council Members Elected
New SATA Council Members Elected!
Dear SATA Members,
The SATA election of the two new executive councilors for our Society’s Council has concluded.
Many thanks to everyone that participated in casting a ballot. Special thanks to all the five excellent candidates who put their names on the list. Thank you for being willing to participate in helping shape the future of our Society.
The SATA Council is happy to announce the newly elected Council members: Dr. Sathish Kumar from the University of Michigan and Dr. Adrian Hendrickse from the University of Colorado (re-elected) for the two-year term (2022 – 2024). We are thrilled to work with you and looking forward to getting the new insights to make SATA a more robust transplant society!
Adrian Hendrickse, BM, MMEd, MAcadMEd, FRCA
(2020 – 2022; reelected – 2024)
Associate Professor of Anesthesiology
Fellowship Program Director, Liver Transplant Anesthesiology
University of Colorado Anschutz Medical Campus
Sathish S. Kumar, MD
(2022 – 2024)
Clinical Associate Professor,
Department of Anesthesiology
University of Michigan
Special thanks and kudos to Dr. Ranjit Deshpande from Yale University (2020 – 2022) for his outstanding job in the past two years as a SATA Council member. Dr. Deshpande helped create our Society’s Finance and Critical Care Committees during his tenure. Dr. Deshpande will continue his work for SATA with his involvement in the committees above. He will also serve as a non-voting Council member.
Lorenzo De Marchi, MD.
Tetsuro Sakai, MD, PhD, MHA
New Leadership at SATA
New leadership of SATA is 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.
Building in Progress
Help us get better!
We are constantly working to improve the quality of information published throughout our website. We are undergoing a website restructure at the moment. Please, if you see a broken link or other problem with our website fill out our contact form below!
UNOS: COVID-19 Resources
Covid-19 Related Resources from UNOS
We would like to provide our members with access to content within our website and beyond. The UNOS website has excellent resources for transplant programs regarding how COVID-19 may affect organ allocation, procurement and other recommendations.
Liver Transplant Simulation for Anesthesiology Residents & Fellows
Great tool for residents and fellows to learn the basics of liver transplant anesthesia.
This is a smart phone application designed to teach you about the anesthetic management of an orthotopic liver transplant. It is designed for medical students, residents, and attendings.