title: Anesthetic management for resection of hepatic paraganglioma metastatic from the donor organ in an orthotopic liver transplant recipient: a case report.
abstract: This is a case report of the anesthetic management for the hepatic resection of a metastatic paraganglioma in a patient with a history of prior orthotopic liver transplantation. Of interest, the metastatic paraganglioma originated from the donor organ. The patient is an 80-year-old woman with multiple medical problems including a history of cryptogenic cirrhosis who underwent successful orthotopic liver transplantation 9 years prior. She later presented with signs and symptoms of catecholamine excess suggestive of a catecholamine-producing tumor (paraganglioma or pheochromocytoma). Elevated urine catecholamine levels and radiographic evidence of a paraganglioma in the transplanted liver metastatic from the donor organ confirmed the diagnosis. Radiofrequency ablation of the tumor and surgical resection was previously attempted without success. We describe the anesthetic management for the successful resection of the metastatic hepatic paraganglioma, which was complicated by profound intraoperative hypertension and hypotension that necessitated the use of multiple vasoactive infusions, extensive surgical blood loss requiring blood transfusion, and difficult glycemic control in an insulin-dependent diabetic patient. The postoperative course is also described. This unique case presented the anesthesia team with challenges specific to both surgery for hepatic resection as well as for catecholamine-secreting tumors. We are not aware of any reports of paragangliomas of either donor or recipient origin involving a transplanted liver, making this the first such report to the best of our knowledge.
authors.affiliation: University of California-Los Angeles, Los Angeles, California 90095, USA. shasharma@mednet.ucla.edu
authors.forename: S
authors.initials: S
authors.lastname: Sharma
authors.forename: C
authors.initials: C
authors.lastname: Wray
authors.forename: H
authors.initials: H
authors.lastname: Nourmand
mesh_terms: D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D016063:Blood Loss, Surgical / Q000517:prevention & control; D017707:Erythrocyte Transfusion; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D010236:Paraganglioma, Extra-Adrenal / Q000503:physiopathology / Q000556:secondary* / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents