title: Organ protection in allograft recipients: anesthetic strategies to reduce postoperative morbidity and mortality.
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: aInstitute of Anesthesiology, University Hospital Zurich bInstitute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Hovaguimian
authors.forename: Martin
authors.initials: M
authors.lastname: Schläpfer
authors.forename: Beatrice
authors.initials: B
authors.lastname: Beck-Schimmer
mesh_terms: D064591:Allografts; D000758:Anesthesia / Q000379:methods*; D000777:Anesthetics / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control*; D051799:Delayed Graft Function; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D009017:Morbidity; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*
chemical_list: D000777:Anesthetics