TY - JOUR
T1 - Unexplained and prolonged perioperative hypotension after orthotopic liver transplantation
T2 - Undiagnosed systemic mastocytosis
AU - Willingham, Darrin L.
AU - Pelris, Prith
AU - Canabal, Juan M.
AU - Krishna, Murii
AU - Hewitt, Winston R.
AU - Shine, Timothy S.J.
AU - Arasi, Lisa C.
AU - Aranda-Michel, Jaime
AU - Hughes, Christopher B.
AU - Kramer, David J.
PY - 2009
Y1 - 2009
N2 - Arterial vasodilation is common in end-stage liver disease, and systemic hypotension often may develop, despite an increase in cardiac output. During the preparation for and the performance of orthotopic liver transplantation, expected and transient hypotension may be caused by induction agents, anesthetic agents, liver mobilization, or venous clamping. A mild decrease of the already low systemic vascular resistance is often observed, and intermittent use of short-acting agents for vasopressor support is not uncommon. In this report, we describe a patient with unexpected and prolonged hypotension due to vasodilation during and after orthotopic liver transplantation. The preoperative end-stage liver disease evaluation, intraoperative events, and intensive care unit course were reviewed, and no cause for the vasodilation and prolonged hypotension was evident. The explant pathology report was later available and showed systemic mastocytosis. We hypothesize that the unexpected hypotension and vasodilation were caused by mast cell degranulation and its systemic effects on arterial tone.
AB - Arterial vasodilation is common in end-stage liver disease, and systemic hypotension often may develop, despite an increase in cardiac output. During the preparation for and the performance of orthotopic liver transplantation, expected and transient hypotension may be caused by induction agents, anesthetic agents, liver mobilization, or venous clamping. A mild decrease of the already low systemic vascular resistance is often observed, and intermittent use of short-acting agents for vasopressor support is not uncommon. In this report, we describe a patient with unexpected and prolonged hypotension due to vasodilation during and after orthotopic liver transplantation. The preoperative end-stage liver disease evaluation, intraoperative events, and intensive care unit course were reviewed, and no cause for the vasodilation and prolonged hypotension was evident. The explant pathology report was later available and showed systemic mastocytosis. We hypothesize that the unexpected hypotension and vasodilation were caused by mast cell degranulation and its systemic effects on arterial tone.
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U2 - 10.1002/lt.21762
DO - 10.1002/lt.21762
M3 - Article
C2 - 19562703
AN - SCOPUS:68349139316
SN - 1527-6465
VL - 15
SP - 701
EP - 708
JO - Liver Transplantation
JF - Liver Transplantation
IS - 7
ER -