title: Liver Transplant From Unexpected Donation After Circulatory Determination of Death Donors: A Challenge in Perioperative Management.
abstract: Unexpected donation after circulatory determination of death (uDCD) liver transplantation is a complex procedure, in particular when it comes to perioperative recipient management. However, very little has been published to date regarding intraoperative and immediate postoperative care in this setting. Herein, we compare perioperative events in uDCD liver recipients with those of a matched group of donation after brain death liver recipients. We demonstrate that the former group of recipients suffers significantly greater hemodynamic instability and derangements in coagulation following graft reperfusion. Based on our experience, we recommend a proactive recipient management strategy in uDCD liver transplantation that involves early use of vasopressor support; maintaining adequate intraoperative levels of red cells, platelets, and fibrinogen; and routinely administering tranexamic acid before graft reperfusion.
authors.affiliation: Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Blasi
authors.affiliation: General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: A J
authors.initials: AJ
authors.lastname: Hessheimer
authors.affiliation: Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Beltrán
authors.affiliation: Hemotherapy & Hemostasis, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Pereira
authors.affiliation: Hepatology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Fernández
authors.affiliation: Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Balust
authors.affiliation: Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Martínez-Palli
authors.affiliation: General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Fuster
authors.affiliation: Hepatology, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Navasa
authors.affiliation: General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: García-Valdecasas
authors.affiliation: Anesthesia, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Taurá
authors.affiliation: General and Digestive Surgery, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Fondevila
mesh_terms: D000368:Aged; D001778:Blood Coagulation Disorders / Q000209:etiology*; D001926:Brain Death; D019468:Disease Management; D005260:Female; D006085:Graft Survival; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000379:methods*