Cardiac Events Within the 30-Day Postoperative Period Is Associated With Increased 1-Year Mortality Among Deceased-Donor Liver Transplant Recipients

The Efficacy of Mannitol in Attenuating Postreperfusion Syndrome in Orthotopic Liver Transplantation: A Retrospective Cohort Study

Introduction: Postreperfusion syndrome (PRS) is associated with complications following liver transplantation (LT). Mannitol may play a role in attenuating PRS as a free radical scavenger. This study aimed to evaluate the association between intraoperative mannitol administration and the incidence of PRS and postoperative acute kidney injury (AKI) in LT. Methods: A retrospective analysis of adult liver-only transplantation between August 2019 and January 2023 at the Mount Sinai Hospital was performed. Patients in the mannitol group received 25G of the drug intravenously prior to reperfusion. Any recipients with pre-existing renal diagnoses were excluded. Demographic, laboratory, intraoperative, and hospital course data were extracted from an institutional data warehouse. Multivariable logistic regressions were used to evaluate the association between mannitol administration and PRS, AKI, early allograft dysfunction, and postoperative cardiac complications. Negative binomial regression was used to evaluate the association with postoperative length of stay (LOS) and ICU LOS. Results: 495 LT cases were included. A total of 81 patients received mannitol before graft reperfusion, while 414 patients did not. The incidence of PRS in patients who received mannitol was 13% and 17% for those who did not receive mannitol (p = 0.53). Additionally, 79% of patients who received mannitol experienced AKI at 7 days, compared to 73% in those who did not receive mannitol (p = 0.48). In the multivariable regression models, mannitol administration was not associated with decreased incidence of PRS or postoperative AKI. It was, however, associated with increased postoperative cardiac complications (risk-adjusted odds ratio 2.70, 95% confidence interval 1.15-6.14, p = 0.02). Conclusions: Mannitol administration during LT was not an effective therapy for reducing PRS or postoperative AKI.

Intraoperative Type I Acute Myocardial Infarction During Liver Transplant Requiring Intra-Aortic Balloon Pump: A Case Report

We describe a complex case of liver transplant in a 70-year-old male patient with no known history of coronary artery disease, normal preoperative left ventricular function, and negative preoperative cardiac workup who developed progressive intra-operative left ventricular myocardial dysfunction secondary to class I acute myocardial infarction, ultimately requiring intraoperative intra-aortic balloon pump insertion to optimize myocardial perfusion. Management of myocardial ischemia was complicated by bleeding in the setting of coagulopathy necessitating correction. Once hemostasis was achieved, the patient immediately underwent coronary angiography and bare metal stent placement in the mid-left anterior descending coronary artery for an acute plaque rupture.