Liver Transplant

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Welcome to the UCSF Liver Transplant Anesthesia website! Liver transplant anesthesia is a division of the Department of Anesthesia and Perioperative Care at UCSF. We are proud to be an integral part of the liver transplant team at UCSF, one of the largest and most successful liver transplant programs in the country. Our mission is to provide outstanding clinical care to transplant patients and all patients with end-stage liver disease. Our team is also dedicated to excellence in teaching and is at the forefront of exciting clinical and translational research within transplantation. On this website, we present our team members, highlight our research endeavors, provide information about our clinical service, and share resources for the resident rotation. For those interested in our one-year fellowship position, more information can be found here. 

Kate Kronish, MD
Chief, Division of Liver Transplant Anesthesia

 

 

Clinical Service

UCSF has a world class Transplant Division with a distinctly robust and high-volume Liver Transplant service that includes a team of highly specialized nurses, nurse practitioners, social workers, hepatologists, intensivists, transplant surgeons and liver transplant anesthesiologists. UCSF consistently exceeds the national average transplant rate with 180-200 transplants per year, including approximately 30 living donor liver transplants. We have the privilege of caring for some of the most medically complex, high acuity patients. 55% of our liver transplant recipients have MELD scores of 15 or greater and 30% of our recipients have MELD scores greater than 30. Despite the severity of illness of our transplant recipients, we have exceptional graft and patient outcomes, with a 93% recipient one-year survival with functioning graft and an 85% 3-year survival with functioning graft. In 2017, the Liver Transplant Program at UCSF earned the highest score for risk adjusted outcomes based on data from the Scientific Registry of Transplant Recipients (SRTR). For more detailed information on transplant demographics and outcomes at UCSF and other centers, visit https://www.srtr.org/

UCSF has the second largest living donor liver transplant program in the United States. We take a multidisciplinary and comprehensive approach to the care of both donors and recipients that involves close collaboration between the transplant surgeons and liver transplant anesthesiologists. 

As part of the hepatobiliary service, the liver transplant anesthesia team also provides expert anesthetic care to patients undergoing hepatic resections and biliary reconstruction, as well as to those with end-stage liver disease undergoing other complex surgical procedures.

Meet the Team

Anesthesia Liver Transplant and Critical Care Team 

 

 

 

Adult Liver Transplant:
Dieter Adelmann
Michael Bokoch
Helge Eilers
John Feiner
Kate Kronish
Linda Liu
Manny Pardo
Amreen Rahman
David Shimabukuro
Steve Weston

Pediatric Liver Transplant:
Irfan Kathiriya
Hung Nguyen
Steve Weston

 

Studies and Projects

Mild Hypothermia and Acute Kidney Injury in Liver Transplantation (MHALT):

The Liver Transplant Anesthesia Divisionis currently conducting the Mild Hypothermia and Acute Kidney Injury in Liver Transplantation (MHALT) Trial. Acute kidney injury (AKI) is a major complication that impairs recovery after liver transplantation and can lead to increased mortality, graft loss, costs, and ICU and hospital length of stay. Mild hypothermia (34-35°C) has been shown in animal models, and more recently in deceased kidney donors, to help preserve kidney function after ischemic injury or transplantation. MHALT (NCT03534141) is a single-blind, randomized controlled trial of mild hypothermia during liver transplantation (see figure) that aims to determine the optimum patient core temperature to preserve post-operative kidney function. MHALT is currently enrolling subjects. The study is funded by a Department of Anesthesia & Perioperative Care Seed Award and a UCSF REAC grant.

 

Liver Transplant Quality Improvement Database: 

The liver transplant anesthesia group maintains a comprehensive perioperative data repository that includes recipient transplant data since 2010. This database captures an extensive range of preoperative and intraoperative variables that allow us to query our practices and outcomes and subsequently refine our approach to provide the best care possible. 

Transplant Outcomes in Anesthesia Database

Liver transplantation is a multidisciplinary collaboration between multiple teams of health care practitioners (nurses, surgeons, anesthesiologists, hepatologists, and intensivists), as well as organ procurement organizations (OPOs). The unification of data from disparate sources is a critical step toward investigating liver transplant outcomes. The Transplant Outcomes in Anesthesia Database (TOAD) consolidates and structures EMR and non-EMR data generated by UCSF surgeons and anesthesiologists, as well as OPO data regarding the organ donor and the procurement processes. This database facilitates quality improvement of surgical and anesthetic management for the UCSF Liver Transplant team and serves as a proof of concept for the integration of patient data sources.

Interesting Articles/Papers  

Claus Niemann, senior member of the liver transplant anesthesia team and co-director of the Ischemic Organ Injury Lab, and is actively involved in donor organ research. Niemann and colleagues published in NEJM their work showing that mild hypothermia in deceased organ donors significantly reduced delayed graft function in kidney transplant recipients.  Further information about this study found here.

When brain-dead organ donors were cooled, their kidneys worked better in transplant recipients

Notable Publications

Our liver transplant anesthesia team has contributed extensively to the body of literature regarding liver transplantation and donor management. Below is a sample publication list.

The Impact of Deceased Donor Liver Extraction Time on Early Allograft Function in Adult Liver Transplant Recipients.
Adelmann D, Roll GR, Kothari R, Syed S, Burdine LJ, Tavakol M, Niemann CU.
Transplantation. 2018 Nov;102(11):e466-e471

Desmopressin Reverses Overly Rapid Serum Sodium Correction in a Hyponatremic Patient Undergoing Living Donor Liver Transplantation: A Case Report.
Brinson EL, Yu JS, Liu LL, Bokoch MP.
A A Pract. 2018 Aug 1;11(3):82-84. 

Intraoperative Management of Liver Transplant Patients Without the Routine Use of Renal Replacement Therapy.
Adelmann D, Olmos A, Liu LL, Feiner JR, Roll GR, Burdine L, Tavakol M, Syed S, Orandi BJ, Niemann CU.
Transplantation. 2018 May;102(5):e229-e235. doi: 10.1097/TP.0000000000002137.

Central venous pressure monitoring in living donor kidney recipients does not affect immediate graft function: A propensity score analysis.
Adelmann D, Bicknell L, Niemann CU, Feiner J, Roll GR, Burdine L, Whitlock EL.
Clin Transplant. 2018 May;32(5):e13238. doi: 10.1111/ctr.13238. Epub 2018 Mar 30.

Anesthesia for Liver Transplantation.
Adelmann D, Kronish K, Ramsay MA.
Anesthesiol Clin. 2017 Sep;35(3):491-508. doi: 10.1016/j.anclin.2017.04.006. Epub 2017 Jul 10. Review.

Therapeutic Hypothermia in Deceased Organ Donors and Kidney-Graft Function.
Niemann CU, Feiner J, Swain S, Bunting S, Friedman M, Crutchfield M, Broglio K, Hirose R, Roberts JP, Malinoski D.
N Engl J Med. 2015 Jul 30;373(5):405-14. doi: 10.1056/NEJMoa1501969.

Impact of a quality improvement project on deceased organ donor management.
Olmos A, Feiner J, Hirose R, Swain S, Blasi A, Roberts JP, Niemann CU.
Prog Transplant. 2015 Dec;25(4):351-60. doi: 10.7182/pit2015129

Optimizing cost-effectiveness in perioperative care for liver transplantation: a model for low- to medium-income countries.
Rando K, Niemann CU, Taura P, Klinck J.
Liver Transpl. 2011 Nov;17(11):1247-78. doi: 10.1002/lt.22405.

Critical care of the end-stage liver disease patient awaiting liver transplantation.
Findlay JY, Fix OK, Paugam-Burtz C, Liu L, Sood P, Tomlanovich SJ, Emond J.
Liver Transpl. 2011 May;17(5):496-510. doi: 10.1002/lt.22269. Review.

Multivessel coronary artery disease predicts mortality, length of stay, and pressor requirements after liver transplantation.
Yong CM, Sharma M, Ochoa V, Abnousi F, Roberts J, Bass NM, Niemann CU, Shiboski S, Prasad M, Tavakol M, Ports TA, Gregoratos G, Yeghiazarians Y, Boyle AJ.
Liver Transpl. 2010 Nov;16(11):1242-8

Predictors associated with terminal renal function in deceased organ donors in the intensive care unit.
Blasi-Ibanez A, Hirose R, Feiner J, Freise C, Stock PG, Roberts JP, Niemann CU.
Anesthesiology. 2009 Feb;110(2):333-41.

Acute kidney injury during liver transplantation as determined by neutrophil gelatinase-associated lipocalin
Niemann CU, Walia A, Waldman J, Davio M, Roberts JP, Hirose R, Feiner J: Acute kidney injury during liver transplantation as determined by neutrophil gelatinase-associated lipocalin. Liver Transpl 2009; 15:1852–60

Central venous pressure monitoring during living right donor hepatectomy
Niemann CU, Feiner J, Behrends M, Eilers H, Ascher NL, Roberts JP: Central venous pressure monitoring during living right donor hepatectomy. Liver Transpl 2007; 13:266–71

 

 

Fellowship

Liver Transplant Anesthesia Fellowship

To learn more about the Liver Transplant Anesthesia Fellowship, please visit the Fellowship page.