Preemptive VAE-An Important Tool for Managing Blood Loss in MVT Candidates With PMT.

Journal Article (Journal Article)

Explantation of native viscera in multivisceral transplant candidates, particularly in those with extensive portomesenteric thrombosis (PMT), carries considerable morbidity due to extensive vascularized adhesions. Preemptive visceral angioembolization has been previously described as a technique to minimize excessive blood loss during mobilization of the native viscera but is not well described specifically in patients with extensive PMT. Methods: In a series of 5 patients who underwent mutivisceral transplant for PMT from June 2015 to November 2018, we performed preoperative superior mesenteric, splenic, and hepatic artery embolization to reduce blood loss during explanation and evaluated the blood loss and blood product utilization, as well as 30-day rates of infectious complications. Results: Following preemptive embolization, median total blood loss was 6000 mL (range 800-7000 mL). The median transfusion requirements were as follows: 16 units packed red blood cells (range 2-47), 14 units fresh frozen plasma (range 0-29), 2 units cryoprecipitate (range 1-14), 4 units platelets (range 2-10), and 500 mL cell saver autotransfusion (range 0-1817). In the first 30 postoperative days, 2 out of 5 patients developed positive blood cultures and 3 out of 5 developed complex intra-abdominal infections. Two patients developed severe graft pancreatitis resulting in mycotic aneurysm of the aortic conduit; bleeding from the aneurysm led to 1 patient mortality. Conclusions: Preoperative embolization is an effective modality to mitigate exsanguinating blood loss during multivisceral transplant in patients with portomesenteric thrombosis; however, it is unclear if the resultant native organ ischemia during explant carries clinically relevant consequences.

Full Text

Duke Authors

Cited Authors

  • Borle, DP; Kesseli, SJ; Barbas, AS; Rege, AS; Vikraman, D; Kadiyala, R; Kim, CY; Smith, TP; Suhocki, PV; Sudan, DL

Published Date

  • March 2021

Published In

Volume / Issue

  • 7 / 3

Start / End Page

  • e670 -

PubMed ID

  • 34104709

Pubmed Central ID

  • PMC8183802

International Standard Serial Number (ISSN)

  • 2373-8731

Digital Object Identifier (DOI)

  • 10.1097/TXD.0000000000001121

Language

  • eng

Conference Location

  • United States