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Chapter 24 - Peri-operative care and early complications
- from Section 4 - Liver
- Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
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- Book:
- Organ Transplantation
- Published online:
- 07 September 2011
- Print publication:
- 11 August 2011, pp 199-211
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Summary
This chapter outlines the pathophysiology of liver disease as it affects patient selection and management in the peri-operative period and key aspects of anesthetic, surgical, and early postoperative care. The most important early complications are primary non-function, hepatic artery thrombosis, and bleeding. Pulmonary hypertension is seen in up to 20% of adult liver transplant candidates and is usually identified by transthoracic echocardiography. Full multi-system assessment should be performed before listing for transplantation, and the patient reviewed when a donor liver becomes available. Management of liver transplant recipients between transplantation and discharge is usually undertaken by a multi-disciplinary team that includes intensivists, hepatologists, and transplant surgeons. Most liver recipients are transferred to the intensive care unit (ICU) for postoperative care. Sepsis is common after transplant and is frequently associated with liver dysfunction. Culture results from the donor and targeted antimicrobial treatment should be considered in recipients with unusual presentations of sepsis.
Contributors
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- By Graeme J.M. Alexander, Heung Bae Kim, Michael Burch, Andrew J. Butler, Tanveer Butt, Roy Calne, Edward Cantu, Robert B. Colvin, Paul Corris, Charles Crawley, Hiroshi Date, Francis L. Delmonico, Bimalangshu R. Dey, Kate Drummond, John Dunning, John D. Firth, John Forsythe, Simon M. Gabe, Robert S. Gaston, William Gelson, Paul Gibbs, Alex Gimson, Leo C. Ginns, Samuel Goldfarb, Ryoichi Goto, Walter K. Graham, Simon J.F. Harper, Koji Hashimoto, David G. Healy, Hassan N. Ibrahim, David Ip, Fadi G. Issa, Neville V. Jamieson, David P. Jenkins, Dixon B. Kaufman, Kiran K. Khush, Heung Bae Kim, Andrew A. Klein, John Klinck, Camille Nelson Kotton, Vineeta Kumar, Yael B. Kushner, D. Frank. P. Larkin, Clive J. Lewis, Yvonne H. Luo, Richard S. Luskin, Ernest I. Mandel, James F. Markmann, Lorna Marson, Arthur J. Matas, Mandeep R. Mehra, Stephen J. Middleton, Giorgina Mieli-Vergani, Charles Miller, Sharon Mulroy, Faruk Özalp, Can Ozturk, Jayan Parameshwar, J.S. Parmar, Hari K. Parthasarathy, Nick Pritchard, Cristiano Quintini, Axel O. Rahmel, Chris J. Rudge, Stephan V.B. Schueler, Maria Siemionow, Jacob Simmonds, Peter Slinger, Thomas R. Spitzer, Stuart C. Sweet, Nina E. Tolkoff-Rubin, Steven S.L. Tsui, Khashayar Vakili, R.V. Venkateswaran, Hector Vilca-Melendez, Vladimir Vinarsky, Kathryn J. Wood, Heidi Yeh, David W. Zaas, Jonathan G. Zaroff
- Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
-
- Book:
- Organ Transplantation
- Published online:
- 07 September 2011
- Print publication:
- 11 August 2011, pp vii-x
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ENSO and variability of the Antarctic Peninsula pelagic marine ecosystem
- Valerie J. Loeb, Eileen E. Hofmann, John M. Klinck, Osmund Holm-Hansen, Warren B. White
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- Journal:
- Antarctic Science / Volume 21 / Issue 2 / April 2009
- Published online by Cambridge University Press:
- 19 November 2008, pp. 135-148
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The West Antarctic Peninsula region is an important source of Antarctic krill (Euphausia superba) in the Southern Ocean. From 1980–2004 abundance and concentration of phytoplankton and zooplankton, krill reproductive and recruitment success and seasonal sea ice extent here were significantly correlated with the atmospheric Southern Oscillation Index and exhibited three- to five-year frequencies characteristic of El Niño–Southern Oscillation (ENSO) variability. This linkage was associated with movements of the Southern Antarctic Circumpolar Current Front and Boundary, a changing influence of Antarctic Circumpolar Current and Weddell Sea waters, and eastward versus westward flow and mixing processes that are consistent with forcing by the Antarctic Dipole high-latitude climate mode. Identification of hydrographic processes underlying ecosystem variability presented here were derived primarily from multi-disciplinary data collected during 1990–2004, a period with relatively stable year-to-year sea ice conditions. These results differ from the overwhelming importance of seasonal sea ice development previously established using 1980–1996 data, a period marked by a major decrease in sea ice from the Antarctic Peninsula region in the late 1980s. These newer results reveal the more subtle consequences of ENSO variability on biological responses. They highlight the necessity of internally consistent long-term multidisciplinary datasets for understanding ecosystem variability and ultimately for establishing well-founded ecosystem management. Furthermore, natural environmental variability associated with interannual- and decadal-scale changes in ENSO forcing must be considered when assessing impacts of climate warming in the Antarctic Peninsula–Weddell Sea region.
Krill transport in the Scotia Sea and environs
- Eileen E. Hofmann, John M. Klinck, Ricardo A. Locarnini, Bettina Fach, Eugene Murphy
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- Journal:
- Antarctic Science / Volume 10 / Issue 4 / December 1998
- Published online by Cambridge University Press:
- 07 May 2004, pp. 406-415
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Historical observations of the large-scale flow and frontal structure of the Antarctic Circumpolar Current in the Scotia Sea region were combined with the wind-induced surface Ekman transport to produce a composite flow field. This was used with a Lagrangian model to investigate transport of Antarctic krill. Particle displacements from known krill spawning areas that result from surface Ekman drift, a composite large-scale flow, and the combination of the two were calculated. Surface Ekman drift alone only transports particles a few kilometres over the 150-day krill larval development time. The large-scale composite flow moves particles several hundreds of kilometres over the same time, suggesting this is the primary transport mechanism. An important contribution of the surface Ekman drift on particles released along the continental shelf break west of the Antarctic Peninsula is moving them north-northeast into the high-speed core of the southern Antarctic Circumpolar Current Front, which then transports the particles to South Georgia in about 140–160 days. Similar particle displacement calculations using surface flow fields obtained from the Fine Resolution Antarctic Model do not show overall transport from the Antarctic Peninsula to South Georgia due to the inaccurate position of the southern Antarctic Circumpolar Current Front in the simulated circulation fields. The particle transit times obtained with the composite large-scale flow field are consistent with regional abundances of larval krill developmental stages collected in the Scotia Sea. These results strongly suggest that krill populations west of the Antarctic Peninsula provide the source for the krill populations found around South Georgia.