title: Anesthetic and Perioperative Management of Nontransplant Surgery in Patients After Liver Transplant.
abstract: OBJECTIVE
  We aimed to document the anesthetic management and metabolic, hemodynamic, and clinical outcomes of liver-graft recipients who subsequently undergo nontransplant surgical procedures.
  
  
  METHODS
  We retrospectively analyzed the data of 96 liver-graft recipients who underwent 144 nontransplant surgeries between October 1998 and April 2016 at Başkent University Hospital.
  
  
  RESULTS
  The median patient age at the time of nontransplant surgery was 32 years, and 35% were female (n = 33). The median time between transplant and nontransplant surgery was 1231 days. The most frequent types of nontransplant surgery were abdominal (22%), orthopedic (16%), and urologic (13%). Seventy patients had an American Society of Anesthesiologists status of 2 (49%); the status was 3 in 71 patients (49%) and 4 in 3 patients (2%). Of the 144 procedures, 23 were emergent (16%) and 48% were abdominal. General anesthesia was used in 69%, regional anesthesia in 19%, and sedoanalgesia in 11%. Twenty-five patients required intraoperative blood-product transfusion (17%). Intraoperative hemodynamic instability developed in 17% of patients, and hypoxemia developed in 2%. Eleven patients remained intubated at the end of surgery (8%). Of the 144 procedures, 19 (13%) required transfer to the intensive care unit, 108 (75%) transferred to the ward, and the remaining 17 (12%) were discharged on the same day. Eight patients developed respiratory failure (6%), 7 had renal dysfunction (5%), 4 had coagulation abnormalities (3%), and 10 had infectious complications (7%) in the early postoperative period. The median hospital stay was 4 days, and 5 patients (4%) developed rejection during hospitalization. Five patients died of respiratory or infectious complications (4%).
  
  
  CONCLUSIONS
  Most liver-graft recipients who undergo nontransplant surgery are given general anesthesia, transferred to the ward after the procedure, and discharged without major complications. We suggest that orthotopic liver transplant recipients may undergo nontransplant surgery without any postoperative graft dysfunction.
authors.affiliation: Department of Anesthesiology, Baskent University Hospital, Ankara, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Ersoy
authors.forename: Asude
authors.initials: A
authors.lastname: Ayhan
authors.forename: Aycan
authors.initials: A
authors.lastname: Ozdemirkan
authors.forename: Gulsi Gulsah
authors.initials: GG
authors.lastname: Polat
authors.forename: Pinar
authors.initials: P
authors.lastname: Zeyneloglu
authors.forename: Gulnaz
authors.initials: G
authors.lastname: Arslan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Haberal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000401:mortality; D000768:Anesthesia, General / Q000009:adverse effects / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006993:Hypnotics and Sedatives