title: The influence of the explant technique on the hemodynamic profile during sequential domino liver transplantation in familial amyloid polyneuropathy patients.
abstract: Familial amyloidotic polyneuropathy (FAP) patients present adrenergic cardiac input blockade secondary to amyloid deposits and sympathetic neuropathy. Consequently, their capacity to compensate for hemodynamic changes is limited. To avoid hemodynamic disturbances in sequential liver transplants, a standard procedure with venovenous bypass or inferior vena cava preservation is contemplated. The aim of this study was to evaluate the impact of both techniques on the hemodynamic management and outcome of patients affected by FAP and scheduled for a domino liver transplantation program. We evaluated 36 FAP patients. Venovenous bypass was performed for 20 patients (the venovenous bypass group), whereas the vena cava preservation technique was used for the remaining 16 patients (the cava preservation group). The time that elapsed from FAP diagnosis to liver transplantation was 3.2 +/- 2.7 years. Peripheral neuropathy was present in all patients, autonomic dysfunction was present in 71%, and cardiac involvement was present in 69%. Renal and gastrointestinal manifestations were reported in 19% and 53% of patients, respectively. The 1-, 3-, and 5-year survival rates were 97%, 93%, and 93%, respectively. Intraoperative hemodynamic and cardiac disorders, need for vasoactive drugs, blood loss, and transfusion requirements were recorded. Postoperative outcome and cardiac and renal complications were also recorded. No significant differences in disease severity or demographic characteristics were observed. Among all the variables studied, only the total ischemia time and time in surgery were significantly longer in the venovenous bypass group patients (P < or = 0.05). During the postoperative period, the incidence of minor cardiovascular events, incidence of acute renal dysfunction, and outcomes were similar in the 2 groups. In conclusion, either preservation of the vena cava or the standard technique with venovenous bypass can be safely used in FAP patients during liver transplantation. Liver Transpl 15:869-875, 2009. (c) 2009 AASLD.
authors.affiliation: Department of Anesthesiology, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Bibiana
authors.initials: B
authors.lastname: Escobar
authors.forename: Pilar
authors.initials: P
authors.lastname: Taura
authors.forename: Nelson
authors.initials: N
authors.lastname: Barreneche
authors.forename: Joan
authors.initials: J
authors.lastname: Beltran
authors.forename: Jaume
authors.initials: J
authors.lastname: Balust
authors.forename: Graciela
authors.initials: G
authors.lastname: Martinez-Palli
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Zavala
authors.forename: Angels
authors.initials: A
authors.lastname: Escorsell
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcia-Valdecasas
mesh_terms: D000328:Adult; D028227:Amyloid Neuropathies, Familial / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007511:Ischemia; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases; D011183:Postoperative Complications; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology