title: Liver Transplantation for Hemoperitoneum Secondary to Huge Multiple Hemangiomatosis: A Case Report of a Tele-intensive Care Unit in Deceased-Donor Management.
abstract: BACKGROUND
  Patients with growing and nonresectable liver hemangiomas should be followed up by a transplant center with extensive experience in complex liver disease. They could be treated on an emergency basis with orthotopic liver transplantation, with an expectation of good long-term results.
  
  
  METHODS
  We describe the case of a 37-year-old woman with liver hemangiomatosis followed up for 8 years, who presented with bleeding requiring transfusions and developed hemodynamic instability. We listed her for emergency transplant before her sister's living donor work-up could be completed. A liver from a cadaveric donor became available at a small local hospital with no experience in organ donation. Tele-intensive care unit (tele-ICU) technology was used for providing clinical data electronically to physicians, nurses, and other critical care specialists, creating medication orders, and communicating with on-site caregivers to implement changes in donor care.
  
  
  RESULTS
  The recipient was transplanted on an emergency basis with a specific customization and application of the telemedicine system in the management of the organ procurement by the recipient team. Tele-ICU technology was used for providing an effective intensive care unit service, managing and stabilizing the deceased donor and allowing the procurement to be carried out uneventfully.
  
  
  CONCLUSIONS
  Tele-ICU technology could be a promising resource for emergency transplantation, reducing the urgent need for a living donation and allowing prompt recipient team management of the deceased donor. Our first tele-ICU case offers early confirmation of the feasibility of the telemedicine system in deceased-donor management.
authors.affiliation: 1Abdominal Surgery and Organ Transplant, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gruttadauria
authors.affiliation: 1Abdominal Surgery and Organ Transplant, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy.
authors.forename: Duilio
authors.initials: D
authors.lastname: Pagano
authors.affiliation: 2Critical Care Unit, Department of Anesthesia and Intensive Care, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Burgio
authors.affiliation: 2Critical Care Unit, Department of Anesthesia and Intensive Care, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Arcadipane
authors.affiliation: 2Critical Care Unit, Department of Anesthesia and Intensive Care, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Panarello
authors.affiliation: 3Hepatology Units, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Petridis
authors.affiliation: 1Abdominal Surgery and Organ Transplant, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Cintorino
authors.affiliation: 1Abdominal Surgery and Organ Transplant, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Spada
authors.affiliation: 3Hepatology Units, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vizzini
mesh_terms: D000328:Adult; D003422:Critical Care; D005260:Female; D018325:Hemangioblastoma / Q000150:complications*; D006465:Hemoperitoneum / Q000209:etiology*; D006801:Humans; D007362:Intensive Care Units; D016031:Liver Transplantation; D017216:Telemedicine
keywords: hemoperitoneum; liver hemangiomatosis; liver transplantation; tele-intensive care unit; telemedicine