title: Gastroesophageal and hemorrhagic complications associated with intraoperative transesophageal echocardiography in patients with model for end-stage liver disease score 25 or higher.
abstract: OBJECTIVE
  To investigate major gastroesophageal and hemorrhagic complications that may be related to intraoperative transesophageal echocardiography (TEE) in liver transplant (LT) patients with high model for end-stage liver disease (MELD) score 25 or higher.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Single institution university setting.
  
  
  METHODS
  Of 906 transplant recipients, 656 who had MELD score 25 or higher were included for analysis.
  
  
  METHODS
  Patient demographics, pre- and intraoperative characteristics, and major gastroesophageal and hemorrhagic complications were compared between patients with and without TEE.
  
  
  RESULTS
  Sixty-six percent (433 patients) had intraoperative TEE and 34% (223 patients) did not. One patient in the TEE group had a major gastroesophageal complication (Mallory-Weiss tear). Eleven patients required postoperative gastrointestinal consultation. These patients were distributed evenly between the TEE and non-TEE groups. Eighteen (2.8%) had major hemorrhagic complication (defined as bloody nasogastric output>500 mL in 24 hours postoperatively). Multivariate analysis showed alcoholic cirrhosis had 5.3 higher odds of post-transplant gastroesophageal hemorrhage compared with other indications for transplant (95% confidence interval 1.8-15.8, p<0.001). TEE was not associated with an increased likelihood of major hemorrhagic complication after LT.
  
  
  CONCLUSIONS
  The authors demonstrated that the incidence of major gastroesophageal and hemorrhagic complications following intraoperative TEE in LT patients with MELD score 25 or higher was low.
authors: David Geffen School of Medicine.
authors: Christine C
authors: CC
authors: Myo Bui
authors: Department of Anesthesiology, Ramathibodi Hospital, Mahidol University, Bangkok Thailand.
authors: Apinyachon
authors: A
authors: Worapot
authors: Department of Anesthesiology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, P.R. China.
authors: Wei
authors: W
authors: Xia
authors: Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California.
authors: Lauren
authors: L
authors: Delgado
authors: David Geffen School of Medicine.
authors: Randolph H
authors: RH
authors: Steadman
authors: David Geffen School of Medicine.
authors: Ronald W
authors: RW
authors: Busuttil
authors: David Geffen School of Medicine. Electronic address: vxia@mednet.ucla.edu.
authors: Victor W
authors: VW
authors: Xia
mesh_terms: D000328:Adult; D000368:Aged; D017548:Echocardiography, Transesophageal / Q000009:adverse effects* / Q000379:methods; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000601:surgery*; D004935:Esophageal Diseases / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013272:Stomach Diseases / Q000175:diagnosis / Q000209:etiology
keywords: Mallory-Weiss tear; gastrointestinal complication; hemorrhage; liver transplantation; risk factors; transesophageal echocardiography