Perioperative Care for Organ Transplant Recipient: Time for Paradigm Shift

Abstract

* Correspondence to: Alexander A. Vitin, Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle WA 98195 USA . E-mail: vitin@uw.edu Transplantation medicine, one of the emerging major medical disciplines, encompasses a wide variety of clinical subspecialties. The concept of replacing organs which are failing or showing insufficiency, with single or multiple organs, either artificial or from donors, is accepted in literally every clinical field There is explosive growth in the transplant sector driven by an ever-increasing patient demand fuelled by the already well-proven efficiency of organ transplantation as an ultimate treatment for end-stage organs failure and the ever-expanding infrastructure of the transplantation industry. The foundation of this industry rests on two pillars: transplantation medicine and transplantation science. The sheer magnitude of the progress within the transplantation industry, as it stands today, maybe best illustrated by impressive statistics and facts, accomplishments and ongoing research trends. Today, organ and tissue transplantation operations are being performed in more than one hundred and eleven countries, encompassing about 81 % of the world’s population. New countries are joining this club every year. Close to 140,000 organs are being transplanted every year worldwide. According to the most recently published OPTN data, in the USA alone, from January 1, 1988, to April 30, 2019, 451,847 kidney, 166,383 liver, 73,216 heart 38,989 lung, 23,959 kidneypancreas and numerous other organ transplantations have been performed in the more than eighty transplant programs. The current trend indicates an exponential increase in these numbers [1,2]. Fifteen international and more than 140 national organizations worldwide are ceaselessly promoting and coordinating research outcomes as well as implementing, developing and improving all practical aspects of organ donation and transplantation procedures. Ever since the very first successful solid organ transplants, transplantation-related science has exhibited an exponential growth. Physicians and researchers from many specialities are getting more involved in transplantation medicine, which has outgrown the boundaries of any one speciality and must now be considered a whole new field of medical science in its own right. Results of clinical and experimental research provide imposing and useful data for publication in a myriad of specialist publications worldwide. There are more than seventy-five periodic issues, among which more than forty high-impact journals which publish results of research. A PubMed search returned about 800,000 titles of the indexed publications pertinent to the field of transplantation. Perioperative care of organ transplant candidates or recipients is an exceedingly complex and multifaceted undertaking. It comprises three main components. Pre-operative care includes the selection of the proper candidate. At this stage, the patient’s medical and surgical history, current disease status, treatment progress, success or lack thereof and compliance with numerous medication regimes, are reviewed. The critical portion of the selection includes a current functional status assessment, the ability to tolerate multiple challenges of organ transplant surgery including that experienced during the post-operative period, and, most importantly, the prediction of outcome in both the immediate and long-term. The degree of functional capacity impairment is a matter of continuous re-assessment and optimization in preparation for organ transplantation surgery. Organ transplant surgery is a culmination of the transplantation process. The possibility of transplant surgery is contingent on availability, often immediate, and the proper quality of the donor organ. Intraoperative care for the organ transplant recipient, even in the relatively straightforward cases, is by far one of DOI: 10.2478/jccm-2019-0016