Mark T Keegan1, David R Wright. 1. Division of Critical Care, Department of Anesthesiology, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. keegan.mark@mayo.edu
Abstract
PURPOSE OF REVIEW: To present current knowledge about the metabolic management of patients undergoing solid organ transplantation, and potential organ donors. RECENT FINDINGS: Appropriate management of electrolytes and glucose improves outcome after transplantation, although conflicting evidence exists. Patients with cirrhosis-induced hyponatremia can be successfully transplanted but are at increased risk of postoperative complications. A new class of drugs, the vaptans, that antagonizes arginine vasopressin may be an effective treatment for hyponatremia in transplant candidates. Recent literature has documented the implications, predictors and potential therapies for perioperative hyperkalemia in the transplant population. The debate over appropriate targets for serum glucose in perioperative and critically ill patients has been lively. The documented risk of hypoglycemia associated with 'intensive insulin therapy' has led to the adoption of more conservative glycemic targets. Studies of glycemic control in transplant recipients are limited. SUMMARY: In patients undergoing solid organ transplants, sodium management should aim to minimize an acute change in sodium concentration. Vaptans may be of future use in optimizing patients with cirrhosis prior to transplantation. Pending further studies, a perioperative 'middle ground' target glucose of between 140 and 180 mg/dl seems reasonable at this time.
PURPOSE OF REVIEW: To present current knowledge about the metabolic management of patients undergoing solid organ transplantation, and potential organ donors. RECENT FINDINGS: Appropriate management of electrolytes and glucose improves outcome after transplantation, although conflicting evidence exists. Patients with cirrhosis-induced hyponatremia can be successfully transplanted but are at increased risk of postoperative complications. A new class of drugs, the vaptans, that antagonizes arginine vasopressin may be an effective treatment for hyponatremia in transplant candidates. Recent literature has documented the implications, predictors and potential therapies for perioperative hyperkalemia in the transplant population. The debate over appropriate targets for serum glucose in perioperative and critically illpatients has been lively. The documented risk of hypoglycemia associated with 'intensive insulin therapy' has led to the adoption of more conservative glycemic targets. Studies of glycemic control in transplant recipients are limited. SUMMARY: In patients undergoing solid organ transplants, sodium management should aim to minimize an acute change in sodium concentration. Vaptans may be of future use in optimizing patients with cirrhosis prior to transplantation. Pending further studies, a perioperative 'middle ground' target glucose of between 140 and 180 mg/dl seems reasonable at this time.