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Jin, Chung, Woo, and Hong: Anesthetic Experiences of Liver Transplantation in a New Low Volume Hospital: Ewha Womans University Mokdong Hospital
Original Article

The Ewha Medical Journal 2017; 40(4): 143-148.

Published online: 31 October 2017

DOI: https://doi.org/10.12771/emj.2017.40.4.143

Anesthetic Experiences of Liver Transplantation in a New Low Volume Hospital: Ewha Womans University Mokdong Hospital

So Hee Jin, Rack Kyung Chung, Jae Hee Woo, Geun Hong1

Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, Seoul, Korea.

1Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea.

Corresponding author: Rack Kyung Chung. Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea. Tel: 82-2-2650-5236, Fax: 82-2-2650-2924, rkchung@ewha.ac.kr

Received 14 July 2017       Revised 17 September 2017       Accepted 20 September 2017

Copyright © 2017. Ewha Womans University School of Medicine

Ewha Womans University School of Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Liver transplantation (LT) is the only treatment for end stage of liver failure. In Korea, annually it has been performed 1,300 cases. Most of LTs are performed in large volumes centers. More than half of centers performing LT in Korea are low volume hospital and started a LT program recently. We present our four-year experiences and outcomes of anesthesia for LT since 2013.

Methods

Anesthetic and surgical outcomes of 49 consecutive patients who received LT (living donor LT, 21 cases; deceased donor LT, 28 cases) between April 2013 and April 2017 were analyzed retrospectively.

Results

All patients were adult, with the mean age of 53.5±9.2 years. The most common cause of original liver diseases was hepatitis B virus-related liver cirrhosis (40.8%). The mean MELD (Model for End-stage Liver Disease) score was 18.8±10.7. Postreperfusion syndrome was observed in 34.7%, which were all controlled by calcium, norepinephrine, ephedrine and epinephrine. The mean postoperative intensive care unit stay of deceased donor LT recipients (13.6±9.0 days) was significantly longer than that of living donor LT recipients (8.0±3.3 days). There was no intraoperative mortality in patients receiving LT. Thirty-day post-transplant survival rate was 93.8% and 3-year survival rate was 88.6 %. The most common postoperative complication was pneumonia.

Conclusion

We have started LT successfully with multidisciplinary team's steady effort. Adaptation and setting up LT protocol, adequate equipment, proper training at established transplant centers are essential to begin a successful LT program.

Keywords: Liver transplantation, Anesthesia, Hospitals, low-volume

Figures and Tables

Fig. 1

Overall post-transplant survival rate. Patient post-transplant survival rate was analyzed by Kaplan-Meier. The 30-day survival rate after transplantation was 93.8% and the 3-year survival rate after transplantation was 88.6%.

emj-40-143-g001
Table 1

Characteristics of recipients

emj-40-143-i001

Values are presented as mean±standard deviation (interquartile range) or number.

DD, deceased donor; LD, living donor; MELD, Model for End-stage Liver Disease; LC, liver cirrhosis; HBV, hepatitis B viral; HCV, hepatitis C viral.

AIndependent t-test was done.

BChi-square test was done.

*P<0.05 (LD vs. DD).

Table 2

Operative data

emj-40-143-i002

Values are presented as mean±standard deviation (interquartile range) or number (%).

DD, deceased donor; LD, living donor; RBC, red blood cell; FFP, fresh frozen plasma.

AIndependent t-test was done.

BChi-square test was done.

*P<0.05 (LD vs. DD).

Table 3

Postoperative outcomes

emj-40-143-i003

Values are presented as mean±standard deviation (interquartile range). All variables analyzed by independent t-test.

DD, deceased donor; LD, living donor; ICU, intensive care unit.

*P<0.05 (LD vs. DD).

Table 4

Postoperative complications

emj-40-143-i004

Values are presented as number of case (percentage of total patient).

CPM, central pontine myelinolysis.

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