Our Summary

This research paper discusses how to best manage anesthesia in patients undergoing solid organ or reconstructive transplants. The authors focus on specific factors such as reperfusion (restoring blood flow to an organ), ischemic-reperfusion injury (damage caused when blood supply returns to the tissue after a period of lack of oxygen), preconditioning (preparing an organ for transplant), and preserving the organ outside the body before transplant.

When dealing with anesthesia in these cases, the paper highlights the need for thorough pre-assessment and preparation before surgery, appropriate access to the patient’s blood vessels, managing fluids, replacing blood and blood products, monitoring the patient’s heart, using drugs that affect heart function and blood pressure, maintaining balance of electrolytes (essential minerals in the body), and regional anesthesia (numbing a specific part of the body).

Despite the complex and lengthy nature of transplant surgeries, the paper also notes that quickly moving patients to a regular ward after surgery is increasingly common and beneficial.

FAQs

  1. What are the key principles underlying anaesthetic management in solid organ and reconstructive transplantation?
  2. What are the special concerns for anaesthetic management of organ transplant patients?
  3. How is fast-tracking to the surgical ward after transplantation beneficial?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about organ transplant is to closely follow their post-operative care instructions, including taking prescribed medications, attending follow-up appointments, and maintaining a healthy lifestyle to support the function of the transplanted organ. It is also important to communicate any changes in symptoms or concerns to their healthcare team promptly. Additionally, patients should be aware of the potential risks and complications associated with organ transplant and be prepared to take steps to manage them effectively.

Suitable For

Patients who are typically recommended for organ transplant are those with end-stage organ failure, such as kidney, liver, heart, lung, and pancreas failure. These patients have exhausted all other treatment options and are not expected to survive without a transplant. Additionally, they must meet certain criteria such as being medically stable enough to undergo the transplant surgery and able to comply with post-transplant care and medication regimens. The decision to recommend organ transplant is made by a team of healthcare providers, including transplant surgeons, transplant coordinators, and other specialists, based on the patient’s medical history, diagnostic test results, and overall health status.

Timeline

Before organ transplant:

  • Patient is diagnosed with end-stage organ failure and referred for transplant evaluation
  • Patient undergoes extensive medical and psychological evaluation to determine eligibility for transplant
  • Patient is placed on waiting list for suitable donor organ
  • Patient undergoes pre-operative optimisation and preparation for surgery
  • Donor organ is procured and transported to transplant center
  • Patient is prepared for surgery, including anaesthetic management and monitoring

After organ transplant:

  • Patient undergoes surgery to receive donor organ
  • Patient is closely monitored in the intensive care unit post-operatively for complications
  • Patient is started on immunosuppressive medications to prevent organ rejection
  • Patient undergoes extensive rehabilitation and follow-up care to monitor organ function and overall health
  • Patient may experience complications such as infection, rejection, or side effects from medications
  • Patient gradually resumes normal activities and quality of life improves with successful transplant.

What to Ask Your Doctor

  1. What is the success rate of the specific organ transplant procedure I am considering?
  2. What are the potential risks and complications associated with the transplant surgery?
  3. How long is the recovery process expected to take?
  4. What medications will I need to take post-transplant and what are the potential side effects?
  5. How often will I need to follow up with my transplant team after the surgery?
  6. What lifestyle changes will I need to make after the transplant?
  7. How will the transplant surgery affect my overall health and well-being in the long term?
  8. Are there any support groups or resources available to help me through the transplant process?
  9. What is the expected life expectancy after receiving a transplant?
  10. Are there any alternative treatment options to consider before proceeding with a transplant surgery?

Reference

Authors: Milan Z, Cortes M, Sarma N. Journal: Injury. 2019 Dec;50 Suppl 5:S126-S130. doi: 10.1016/j.injury.2019.10.063. Epub 2019 Oct 22. PMID: 31727399