Chapter 33 Organ Transplantation
1. What are the most commonly transplanted organs?
2. How does donation after brain death differ from donation after cardiac death?
3. What conditions preclude transplantation?
4. What is the most common cause of death in organ transplant recipients?
5. Most transplant candidates are screened for comorbidities prior to being waitlisted. What additional beneficial preoperative measures can be undertaken once a donor is identified?
Kidney transplantation
6. Who is a candidate for renal transplantation?
7. What is the major cause of death in dialysis patients?
8. What differs between an extended criteria donor kidney and a standard criteria donor graft?
9. Where is the donor kidney transplanted in the recipient patient? From where does it derive its vascular supply? Where is the ureter anastomosed?
10. What are the preoperative considerations for the patient scheduled to undergo renal transplantation?
11. How is preoperative ischemic heart disease ruled out prior to transplant listing?
12. What is the usual general anesthetic regimen administered for renal transplantation?
13. What consideration must be made when selecting a neuromuscular blocking drug for patients undergoing renal transplantation?
14. Why is optimal hydration important during renal transplantation? What type of crystalloid solution should be used for hydration? What monitoring method may be used to help guide hydration intraoperatively for renal transplantation?
15. Is dopamine of benefit during renal transplant procedures?
16. Why is mannitol administered intraoperatively during renal transplant procedures?
17. Cardiac arrest after completion of the renal artery anastomosis is thought to be secondary to what?
Liver transplantation
18. Who is a candidate for liver transplantation?
19. How are liver transplant recipients prioritized for organ allocation?
20. What is the 1-month mortality for a waitlisted candidate with a high model for end-stage liver disease (MELD) score (score > 30)?
21. What physiologic disturbances are often present in patients before liver transplantation?
22. What is the best screening test for portopulmonary hypertension?
23. What is hepatopulmonary syndrome? Why is it significant?
24. What types of monitoring may be used intraoperatively during liver transplantation?
25. What types of intravenous access are typically established preoperatively for liver transplant procedures? Why should placement be supradiaphragmatic?
26. Why are cell-saver devices used intraoperatively for liver transplantation?
27. Why is calcium administration often required during liver transplantation?
28. What are the three stages of liver transplant procedures?
29. What are the characteristic physiologic derangements of the preanhepatic stage of liver transplant procedures?
30. What are the characteristic physiologic derangements of the anhepatic stage of liver transplant procedures?
31. What is the “piggy-back” technique and why is it used in some patients?
32. What are the characteristic physiologic derangements that occur with reperfusion of the donor graft during liver transplant procedures?
33. Which coagulopathies can occur during liver transplantation?
34. Why is nitrous oxide avoided for maintenance anesthesia during liver transplantation?
35. Why do some anesthesiologists prefer cisatracurium as the nondepolarizing neuromuscular blocking drug for liver transplantation?
36. What signs of donor graft function can be assessed intraoperatively after graft reperfusion?
37. When is extubation of the trachea after liver transplant surgery performed?
Heart transplantation
38. Who is a candidate for heart transplantation? What ejection fraction is commonly seen in patients undergoing heart transplantation?
39. What are the goals for the induction and maintenance of anesthesia for heart transplant patients?
40. What vessels are transected and anastomosed during heart transplant surgery? What does this mean with regard to a central venous or pulmonary artery catheter?
41. What is the indication for isoproterenol during heart transplantation?
42. Does the transplanted heart react better to catecholamines that are direct or indirect acting?
43. Name the physiologic conditions that should be optimized prior to weaning from cardiopulmonary bypass.
44. Name three conditions that may worsen pulmonary hypertension.
