Session Time: 2:30pm-4:00pm
Presentation Time: 3:42pm-3:54pm
Location: Room 209
*Purpose: Organ explant in multivisceral transplant (MVT) candidates is technically demanding associated with high volume blood loss. Visceral arterial embolisation (VAE) may reduce bleeding, but limited experience in MVT has been reported
*Methods: Between June 2015 and Nov 2018 MVT candidates with complete PMT were identified who underwent VAE before or during transplant. Clinical characteristics, intraoperative variables and outcomes were reviewed
*Results: Median recipient age was 44 (40-55) years; 60% were men. Indication for MVT was cirrhosis with PMT precluding isolated liver transplantation. Median MELD was 26 (21-37). Interventional radiologists performed VAE immediately prior to MVT in 4 and intraperatively (after initial attempts at explantation of native viscera) in 1 with interlock coils, Amplatzer plug and gelgoam with or without Trufill glue and Lipiodol including splenic and superior mesenteric arteries in 5; while common hepatic, celiac axis and gasproduodenal artery were embolized in 3,3 and 1 patients respectively. Median blood loss was 6000 (800-7000) ml. Transfusion requirements were: red blood cell 16 (2-47) units, fresh frozen plasma 14 (0-29) units, cryoprecipitate 2 (1-14) units, platelets 4 (2-10) units. Advantage of VAE was clear in 2 cases: in patient undergoing intraoperative VAE, there was markedly improved hemodynamic stability, decreased vasopressor requirement and blood loss after embolisation. In a second patient, incomplete occlusion of arterial flow due to challenging vascular anatomy was associated with large volume blood loss (47 units of red cell transfusion). Time from incision to explant was 420 (198-490) min. Median lactate values pre-,post-VAE and at end of surgery were 4.1 (2.1-10.1), 5.8 (3.1-10.6), 4.2 (2.4-6.3) respectively. No correlation was identified between lactate level and length of the explant, transfusion volume, vasopressor use or postoperative infections. In 2 out of the 5 patients infection with multiple atypical organisms including non Tuberculous Mycobacteria and various Candida species were identifies; 1 of the 2 died. Both patients had prolonged cold schema times (557 and 474 min) compared to recipients who did not develop infections (average 347 min)
*Conclusions: MVT in candidates with PMT is associated with large volume blood loss and hemodynamic instability which can be improved with VAE. Further studies are needed however to determine the contribution of native gut necrosis, to the occurrence of potentially life-threatening atypical infections.
To cite this abstract in AMA style:Borle DP, Shah JA, Venkata RKadiyala, Vikraman D, Collins B, Knechtle S, Rege A, Barbas A, Kim C, Smith T, Sohocki P, Sudan DL. Visceral Arterial Embolization – An Important Tool For Managing Blood Loss In Multivisceral Transplant Candidates With Portomesenteric Thrombosis [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/visceral-arterial-embolization-an-important-tool-for-managing-blood-loss-in-multivisceral-transplant-candidates-with-portomesenteric-thrombosis/. Accessed August 14, 2020.
« Back to 2019 American Transplant Congress