Organ Transplantation: A Systematic Review

Christopher Wray, MD, EditorView Large Image Figure ViewerDownload Hi-res image Download (PPT)Organ transplantation has evolved significantly since its initial inception in the 1960s. Advances in surgical techniques, immunosuppression, and perioperative management strategies have resulted in continued improvements in graft viability and posttransplant patient survival. Organ transplantation is now widespread and growing on an international level. In concordance with these developments, the field of transplant anesthesiology has evolved as well. Today, highly specialized anesthesia teams are crucial to the success of transplant programs. Transplant anesthesiologists are involved in all aspects of the perioperative care of transplant patients, including the preoperative selection of transplant candidates, the intraoperative management of complex transplant surgeries, and the postoperative critical care of transplant recipients. Anesthesiologists in these teams have driven crucial research and patient care strategies that are central to the progress of organ transplantation. Heart and lung transplant teams rely on specially trained cardiac anesthesia teams. Pediatric anesthesiologists are routinely involved in all phases of pediatric transplantation. Most centers now employ liver transplant anesthesia groups that are dedicated to the specialized perioperative care of the liver transplant patient. Recent development of transplant anesthesia fellowships has contributed to the growth of transplant anesthesia. This issue of Anesthesiology Clinics provides an updated survey of topics central to the anesthetic care of transplant patients. Experts in their respective fields have contributed state-of-the-art reviews of all categories of transplant anesthesia by organ system. Current research and updated clinical strategies for the anesthetic management of cardiac, lung, liver, kidney/pancreas, and intestinal transplants as well as the management of the organ donor are reviewed in individual articles. Specialized topics central to the care of transplant patients are discussed as well. These include an overview of transplant immunosuppression, a review of posttransplant infection and malignancies, and an update on coagulation management and transfusion in transplant patients. Pediatric experts provide a review of the anesthetic management of pediatric liver and kidney transplant. Reconstructive transplantation is an emerging field and includes hand, face, and tissue composite transplants. Experts in the anesthetic management of reconstructive transplantation provide a review of this novel surgical specialty. As organ transplantation has become widespread, recipients are frequently undergoing nontransplant surgical procedures after successful transplant. An article reviews the anesthetic considerations in transplant recipients for nontransplant surgery with attention to each transplant organ system. Organ transplantation is a dynamic sphere; future changes and challenges are expected. Age limits for transplant candidates are increasing in conjunction with an aging population. Chronic illnesses in older candidates may affect postoperative survival and impact transplant candidacy. End-stage organ disease patterns are also changing; therapies for specific diseases such as hepatitis C virus infection and diabetes may alter future indications for transplantation. Increasingly complex surgical and medical treatment paradigms have been employed in the management of transplant patients. The transplant anesthesiologist is a crucial member of the transplant team and has an important role in future advances. Updated knowledge of the anesthetic considerations for organ transplantation is necessary for both the transplant anesthesiologist and the anesthesiologist involved in the care of patients prior to and after transplant.