Importance of Preventing Inadvertent Perioperative Hypothermia During Liver Transplant

• Published in: Transplantation proceedings Vol. 54; no. 9; pp. 2549 - 2551
• Main Authors: Fernández-Castellano, Guiomar, Pueyo-Périz, Eva Maria, Triano, Macarena Bermúdez, Romero, Juan Luis Lopez, Bravo, Miguel Ángel Gómez, Linero, Inmaculada Benítez
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2022
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2022.10.019

•Inadvertent perioperative hypothermia is a serious, preventable, and frequent complication in major abdominal operations, particularly in liver transplant. This causes important deleterious effects and increased perioperative morbidity.•The importance of our work lies in the fact that is has shown that using a multidisciplinary protocol, standardized, multimodal, and adjusted to the characteristics of the institution, it is possible to reduce the incidence of hypothermia and, above all, its associated complications.
Inadvertent perioperative hypothermia (IPH) leads to a series of deleterious effects that can be especially in complex procedures such as liver transplant. The implementation of a protocol is key to ensure the patient's normothermia.
A cohort of 209 patients who underwent liver transplant in a tertiary hospital in a period between January 2016 and December 2018 was retrospectively analyzed. The patients were divided into 2 groups: group 1, patients with normothermia (core body temperature ≥ 36°C) and group 2, patients with hypothermia (core body temperature < 36°C). Mortality between both groups at 1 month, 1 year, and 3 years is compared. Postoperative morbidity is also compared.
The incidence of IPH is 21.5%. Patients with normothermia present with statistical significance: a lower mortality at 1 year; a lower need for transfusion of platelets, plasma, fibrinogen consumption, or massive polytransfusion; and lower primary graft dysfunction, graft and surgical complications, rejection, hemodynamic complications, and metabolic and surgical reintervention.
No significant differences were found in mortality at 1 month or 3 years in the need for prolonged mechanical ventilation; hospital readmission; length of stay in the intensive care unit or in hospital stay; rate of red blood cell transfusion; vascular, biliary, respiratory, or digestive complications; refractory ascites; or neurologic, kidney, hematological, endocrine, thrombotic, nutritional, or infectious issues.
The incidence of IPH is relatively low in our patients, based on what is described in the literature, and in most cases it is mild. There is a reduction in complications fundamentally related to the consumption of blood products and the graft.