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Organ protection in allograft recipients: anesthetic strategies to reduce postoperative morbidity and mortality

Hovaguimian, Frédériquea; Schläpfer, Martina,b; Beck-Schimmer, Beatricea,b

Current Opinion in Organ Transplantation: April 2014 - Volume 19 - Issue 2 - p 121–130
doi: 10.1097/MOT.0000000000000062
ORGAN PRESERVATION AND PROCUREMENT: Edited by Henrik Petrowsky

Purpose of review: Organ protection remains a primary objective in the anesthetic management of patients undergoing transplantation. An ongoing effort has been made to develop strategies to improve graft outcome and reduce postoperative morbidity and mortality, but trials have reported conflicting results. The aim of this review was to provide a comprehensive summary of the anesthetic management in transplant recipients and to identify current strategies for organ protection.

Recent findings: Decreasing blood products requirements, intraoperative blood glucose control and adequate postoperative pain therapy may improve patient outcome. Vasopressors have been reported to reduce perioperative bleeding but might be associated with postoperative acute renal failure in liver transplantation. Early extubation may increase survival rates in recipients. These perioperative challenges, along with other protective strategies, have been addressed in 20 recently published studies: 10 randomized controlled trials, nine retrospective studies and one prospective study.

Summary: This review identified several promising strategies ensuring organ protection and improving patient outcome after solid organ transplantation. However, as outcomes were difficult to compare, further evidence will be needed before drawing firm conclusions.

aInstitute of Anesthesiology, University Hospital Zurich

bInstitute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland

Correspondence to Beatrice Beck-Schimmer, MD, Institute of Anesthesiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. Tel: +41 44 255 2696; fax: +41 44 255 4409; e-mail: beatrice.beckschimmer@uzh.ch

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins