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2015 oxford textbook of transplant


Oxford Textbook of

Transplant
Anaesthesia and
Critical Care


Oxford Textbooks in Anaesthesia
Oxford Textbook of Anaesthesia for the Elderly Patient
Edited by Chris Dodds, Chandra M. Kumar, and Bernadette Th. Veering
Oxford Textbook of Anaesthesia for Oral and Maxillofacial Surgery
Edited by Ian Shaw, Chandra M. Kumar, and Chris Dodds
Principles and Practice of Regional Anaesthesia, Fourth Edition
Edited by Graeme McLeod, Colin McCartney, and Tony Wildsmith
Oxford Textbook of Cardiothoracic Anaesthesia
Edited by R. Peter Alston, Paul S. Myles, and Marco Ranucci
Oxford Textbook of Transplant Anaesthesia and Critical Care
Edited by Ernesto A. Pretto, Jr., Gianni Biancofiore, Andre De Wolf, John R. Klinck, Claus
Niemann, Andrew Watts, and Peter D. Slinger


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Oxford Textbook of

Transplant
Anaesthesia and
Critical Care
Editor-in-Chief

Ernesto A. Pretto, Jr.
Editors

Gianni Biancofiore
Andre De Wolf
John R. Klinck
Claus Niemann
Andrew Watts
Contributing Editor

Peter D. Slinger

1


1
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Foreword

Organ transplantation began with kidney transplantation in the
early 1950s and expanded to heart, lung, liver, pancreas, multiviscera, and xenograft transplantation. Its evolution over the
past 50 years or so has been dramatic. The experimental stage
of organ transplantation (1960–1980) evolved into the developmental stage (1980–1990) and refinement stage (1991–present)
with excellent clinical outcomes. This evolution has been made
possible by better understanding of the scientific basis of transplantation, which includes immunology and pathophysiology
and continuously improving surgical technique and perioperative care. It is noteworthy that the role of anaesthesiologists
and intensivists has been vital in its progression, because organ
transplantation is a medical field that requires a multidisciplinary approach by dedicated physicians and scientists of all medical fields.
I am extremely pleased to witness the publication of the Oxford
Textbook of Transplant Anaesthesia and Critical Care edited by
Drs Biancofiore, De Wolf, Klinck, Niemann, Pretto, Slinger, and
Watts, who are my respected colleagues and experts in the transplantation field. The major strength of this textbook can be found
in its comprehensiveness and the inclusion of scientific bases. It
begins with the history of organ transplantation and includes

ethics, organ donation, and perioperative management of all
transplanted organs. The molecular basis of organ transplantation should encourage further exploration in organ preservation,
prevention of ischaemic injury, and modulation of rejection phenomena. The book presents many ideas and concepts to guide
the future direction of transplant anaesthesiology, critical care
and research, a vital issue for further development of organ
transplantation.
Organ transplantation, particularly the field of anaesthesiology and critical care medicine, was once believed to be a ‘black
hole’—an amorphous unknown object with a huge mass absorbing all resources without a trace. We now have a much better
understanding of that black hole, and I believe that we are better
equipped to explore the unknown universe with the guidance of
this textbook. As a long-time anaesthesiologist in the transplantation field, I sincerely appreciate all editors and contributors for
their life-time dedication to organ transplantation.
Yoogoo Kang, MD
Professor, Anesthesiology
Director, Hepatic Transplantation Anesthesiology
Thomas Jefferson University



Preface

So the LORD GOD caused a deep sleep to fall upon the man, and he slept; then He took
one of his ribs and closed up the flesh at that place
—Genesis 2:21

Organ transplantation is a relatively new medical science that
has made it possible for patients with an irreversibly damaged
organ, and little hope of long-term survival, to receive a replacement organ from another human-being, living or deceased. This
ancient idea, once also the purview of science-fiction novels, has
become reality, and it is revolutionizing medical care by bringing renewed hope for healing to thousands of patients worldwide,
every day. The only limitation to a much wider application of this
life-saving technology is the scarcity of suitable organs.
The successful and steady evolution of the field of clinical organ
transplantation over the past 100 years or so is directly attributable to the multidisciplinary nature and scientific basis of transplant care. In fact, only since 1995 during which time medical
technology has made great strides forward have we seen marked
improvements in long-term survival, including among recipients of the most complex transplant procedures. In particular,
advances in perioperative and critical care management of the
transplant recipient have accounted to a great extent for these
recent improvements in outcomes.
One of those seminal achievements was the initiation by a group
of anaesthesiologists and intensive care physicians at the University
of Pittsburgh of a multidisciplinary approach to liver transplantation. The first gathering of this group in 1982 was called ‘Anesthesia
and Perioperative Care in Liver Transplantation’, which later
became the International Liver Transplantation Society (ILTS).
In a letter dated 5 August 1993 by Dr Thomas Starzl, a renowned
American liver transplant pioneer, to Dr Peter Safar, a critical care
medicine pioneer and founding Chairman of the Department of
Anesthesiology and Critical Care Medicine at the University of
Pittsburgh, who was then director of what is now known as the
Safar Center for Resuscitation Research, Starzl wrote:
. . . I have always taken pains to point out how what we do would
be utterly impossible without the marvelous collaboration of our
unselfish colleagues who work in the operating room and slave over
these terribly sick patients afterwards. In a much more professionally meaningful but less public way, we have promoted the interests
of the anesthesia and ICU physicians by passing the leadership baton

onto Kang et  al., for the organization of the International Liver
Transplantation Society that will be meeting for the second time
this year in Canada. Dr.  Kang’s efforts and those of his intensive
care colleagues were responsible for the birth of this very important
organization . . . .

In the same vein, the American Society of Anesthesiologists (ASA)
described the nature of anaesthesia practice for organ transplantation, and those anaesthesiologists and intensivists engaged in its
delivery, in the following manner:
The complexity of transplant surgeries requires the expertise and
specialty of a transplant anesthesiologist who is an integral part of
the transplant team. Transplant anesthesiologists have an extensive
background in critical care medicine, cardiac anesthesiology and/
or pediatric anesthesiology. This type of anesthesiologist also provides consultation in both the preoperative and intraoperative stages
of care.

This statement was a first step in the direction of defining the
knowledge base, required training and experience, and scope of
practice of the ‘transplant anaesthesiologist’.
Likewise, a recent ‘landmark’ decision by the Organ Procurement
and Transplantation Network (OPTN)/United Network for Organ
Sharing (UNOS) (the principal government-mandated agency
overseeing organ procurement and sharing in the US), in partnership with the ASA Committee on Transplantation, has promulgated guidelines for the qualifications and clinical responsibilities
of the director of liver transplant anaesthesia programmes, as
follows:
The director of liver transplant anesthesia should have one of the
following:
1.Fellowship training in Critical Care Medicine, Cardiac
Anesthesiology, or a Liver Transplant Fellowship, that includes
the peri-operative care of at least 10 liver transplant recipients.
2.Experience in the peri-operative care of at least 20 liver transplant recipients in the operating room, within the last 5 years.
Experience acquired during postgraduate residency training does
not count for this purpose.


viii

 preface

The director of liver transplant anesthesia has clinical responsibilities that include but are not limited to the following:
◆ Pre-operative

assessment of transplant candidates

◆ Participation

in candidate selection

◆ Intra-operative
◆ Post-operative

management

visits

◆ Participation

on the Selection Committee

◆ Consultation

pre-operatively with subspecialists as needed

◆ Participation

in morbidity and mortality (M&M) conferences
(UNOS Bylaws)

These guidelines provide official recognition that expertly trained
anaesthesiologists are critical to optimizing transplant care. The
UNOS bylaws endorse transplant anaesthesiologists’ active participation in medical decision-making in all facets of transplant care.
We believe these guidelines should not be limited to the care of
liver transplant recipients alone but that the benefits of multidisciplinary care and specialized training in transplant anaesthesia will
inevitably lead to improved care for all types of organ transplant
recipients, as well as organ donors. Other than pain management
and critical care medicine, perhaps there is no other subspecialty of
anaesthesiology where our involvement has been as important to
improved outcomes and as valued by our professional counterparts.
Therefore the impetus for a book on ‘Transplant Anaesthesia
and Critical Care’ derives from the same spirit of collaboration
and collegiality that seeks to affirm the current trend towards
greater specialization in transplant anaesthesia and critical care.
Specifically, this book attempts to define the normative body of

scientific and clinical knowledge, skill, and training that is essential to the expertise of the anaesthesiologist involved in the care of
the organ donor as well as the organ transplant recipient.
On behalf of the editors, the expectation is that the appearance
of this book is timely, relevant, and true to the present state-ofthe-art and that it will bolster the continued development of the
burgeoning field of transplant anaesthesia and critical care. As you
will see on initial perusal of the table of contents we have taken a
holistic approach to the scope of practice of transplant anaesthesia. In so doing we cover in depth many aspects of transplantation
of the major organ systems. Moreover, we have assembled a cadre
of multidisciplinary transplant experts from several continents
that present updated evidence-based information on various topics related to transplantation, including data on organ transplant
practices in leading countries, as well as some of the ethical challenges facing the field of organ transplantation today.
We hope this book will be well received by the medical and scientific communities and that it will serve as the authoritative reference work in the field, thereby forming the basis for the design of
curricula for teaching and training of medical students, anaesthesia residents, transplant anaesthesia fellows, nurse anaesthetists,
and attending anaesthesiologists in transplant care.
Finally, we believe that the future of transplant anaesthesia relies
heavily on discovery. As such we hope this book will provide the reader
with key insights into cellular mechanisms of ischaemia–reperfusion
injury that will inspire transplant anaesthesiologists to engage in
basic and clinical research, and in so doing contribute to the collective advancement of the science of transplantation.
Ernesto A. Pretto, Jr., MD, MPH
Miami Transplant Institute


Contents

Abbreviations  xiii
Editors  xix
Contributors  xxi

SEC TION 1

Introduction
1 History of organ transplantation  3
John R. Klinck and Ernesto A. Pretto, Jr.

2 The development of organ donation systems
and regulatory bodies in the United States  13
Nikole Neidlinger, Sean Van Slyck, and
Daniel M. Bruggebrew

3 Organ donor allocation and transplant
logistics: the European perspective  23
Gabriela A. Berlakovich and Thomas Soliman

SEC TION 2

Introduction to transplant ethics
4 Acquiring organs ethically: problems
and prospects  33
Jamie Lindemann Nelson

5 Organ allocation: a guide for the perplexed  43
Benjamin E. Hippen

6 Ethical issues in transplant tourism
and organ commercialism  53
Robin N. Fiore

SEC TION 3

The organ donor
7 Neurological determination of
death and organ donation  61
Shariq S. Raza, Ali Salim, and Darren J. Malinoski

8 Critical care of the organ donor  69
Matthew B. Bloom, Ali Salim, and Darren J. Malinoski

9 Research in organ donors: future directions  77
Claus Niemann and Andrea Olmos

SECTION 4

The scientific basis of organ
transplantation
10 Organ resuscitation  87
Ernesto A. Pretto, Jr., Kyota Fukazawa, and
Antonello Pileggi

11 Transplant immunology  99
Phillip Ruiz, Junichiro Sageshima, George Burke,
Linda Chen, and Gaetano Ciancio

12Xenotransplantation  111
Kazuhiko Yamada, Joseph Scalea, and Masayuki Tasaki

SECTION 5

Kidney and kidney–pancreas
13 Indications, selection, and evaluation of
the kidney transplant candidate  125
M. Francesca Egidi and Giuseppe Segoloni

14 Kidney transplantation: perioperative
cardiovascular risk and anaesthetic
management  131
Livia Pompei, Maria Gabriella Costa,
Mauricio Sainz-Barriga, George Burke, and
Giorgio Della Rocca

15 Perioperative management of the
kidney–pancreas and pancreas
transplant recipient  141
Ugo Boggi, George Burke, and Kumar Belani


x

  contents

16 Critical care of the kidney, pancreas, and
kidney–pancreas transplant recipient  153
Martin Birch, Robby Sikka, and Kumar Belani

17 Diabetes mellitus: epidemiology,
pathophysiology, and treatment  165
Piero Marchetti, Margherita Occhipinti,
Gabriella Amorese, and Ugo Boggi

18 Islet cell transplantation  171
Antonello Pileggi and Camillo Ricordi

SEC TION 6

 Liver
19 Liver disease: epidemiology, pathophysiology,
and medical management  183
Andre De Wolf, Paul Martin, and Hui-Hui Tan

20 Liver transplantation: patient selection,
organ allocation, and outcomes  201
Vishal C. Patel and John O’Grady

21 Critical care of the patient with liver disease  211
Andrea De Gasperi, James Y. Findlay, and John R. Klinck

22 Liver transplantation: anaesthesia
and perioperative care  223
John R. Klinck and Andre De Wolf

23 Critical care of the liver transplant recipient  239
Samantha Vizzini, Anurag Johri, Faisal Anis,
Ernesto A. Pretto, Jr., and William Peruzzi

24 Perioperative management in live
liver donor transplantation  251
Anand Sharma, Gyu-Sam Hwang, and
Stuart Andrew McCluskey

25 Paediatric liver transplantation: assessment
and intraoperative care  259
James Bennett and Peter Bromley

26 Paediatric liver transplantation: critical care  267
Richard Neal and Oliver Bagshaw

SEC TION 7

Intestinal and multivisceral
27 Anaesthetic management of adult intestinal
and multivisceral transplantation  277
Kyota Fukazawa, Ernesto A. Pretto, Jr., and Seigo Nishida

28 Paediatric intestinal and multivisceral
transplantation: indications, selection,
and perioperative management  285
Lydia M. Jorge and Obi Ekwenna

29 Critical care of the intestinal and
multivisceral transplant recipient  297
Lydia M. Jorge and Haran Fisher

SECTION 8

Heart, lung, and heart–lung
30 Perioperative management of the
heart transplant recipient  307
Alan Ashworth and Andrew Roscoe

31 Anaesthesia for heart–lung transplantation  315
Marcin Wąsowicz

32 Lung transplantation  321
Derek Rosen, Marcelo Cypel, and Peter D. Slinger

33 Intensive care management of heart, lung,
and heart–lung transplant recipients  339
Andrew C. Steel

34 Heart and lung transplantation in the paediatric
and neonatal population: the current era  353
Mazen Faden and Elod Szabo

SECTION 9

Special considerations
35 Geriatric transplant anaesthesia  371
Fouad G. Souki and Michael C. Lewis

36 Transfusion medicine and organ
transplantation  385
Richard Charlewood and Kerry Gunn

37 Coagulation and haemodynamic monitoring  395
Mark Hayman and Andrew Watts

38 Specialized equipment and procedures: blood
salvage, rapid infusion systems, and
renal replacement therapy  407
Andrew Watts and Kirstin Naguit

39 Anaesthesia for non-transplant surgery
in the organ transplant recipient  419
Luz Aguina and Ernesto A. Pretto, Jr.


 

40 The anaesthetic implications of pregnancy
after organ transplantation  429
Katherine G. Hoctor and J. Sudharma Ranasinghe

41 Starting a new organ transplant programme  439
Karina Rando and Gebhard Wagener

42 Quality improvement and data
analysis in transplantation  447
Ryutaro Hirose and Justin Parekh

Index  451

contents

xi



Abbreviations

2,3DPG2,3-diphosphoglycerate
31P-NMR phosphorus-31 nuclear magnetic resonance
6-MWT
6-minute walk test
7DS
seventh day syndrome
99TcMAA technetium-99-radiolabelled macro-aggregated
albumin
A/Cassist-control
A2ALL
Adult to Adult Living Donor Liver Transplantation
Cohort Study
A–aalveolar–arterial
AAA
aromatic amino acid
AAMR
acute antibody-mediated rejection
AASLD
American Association for the Study of Liver
Diseases
AAT
α1-antitrypsin
ABG
arterial blood gas
ABOiABO-incompatible
ACC
American College of Cardiology
ACDA
acid citrate dextrose solution A
ACEangiotensin-converting enzyme
ACLF
acute-on-chronic liver failure
ACO
approved combined organs
ACS
American College of Surgeons
ACTH
adrenocorticotropic hormone
ADA
American Diabetes Association
ADH
antidiuretic hormone
ADP
adenosine diphosphate
AEadverse event
AF
atrial fibrillation
AFPalpha-fetoprotein
AHA
American Heart Association
aHUS
atypical haemolytic–uraemic syndrome
AICD
automatic implantable cardioverter-defibrillator
AIDS
acquired immunodeficiency syndrome
AKBR
arterial ketone body ratio
AKI
acute kidney injury
ALF
acute liver failure
ALG
antilymphocyte globulin
ALI
acute lung injury
ALS
amyotrophic lateral sclerosis
ALT
alanine transaminase
AMP
adenosine monophosphate
AMR
antibody-mediated rejection

ANT
adenosine nucleotide translocator
AOPO
Association of Organ Procurement Organizations
APCantigen-presenting cells
APRV
airway pressure release ventilation
aPTT
activated partial thromboplastin time
AR
acute rejection
ARBangiotensin-receptor
ARDS
acute respiratory distress syndrome 
ARDSNET Acute Respiratory Distress Syndrome Network
ARF
acute respiratory failure
ASN
American Society of Nephrology
ASPEN
American Society of Parenteral and Enteral
Nutrition
AST
American Society of Transplantation
AST
aspartate aminotransferase
ASTS
American Society of Transplant Surgeons
ATG
antithymocyte globulin
ATN
acute tubular necrosis
ATP
adenosine triphosphate
AUC
area under the curve
AVarteriovenous
BALbronchoalveolar lavage
BCAA
branched-chain amino acid
BH
Berlin Heart EXCOR®
BiPAP
bilevel positive airway pressure
BISbispectral index
BiVAD
biventricular assist device
BMbone marrow
BMI
body mass index
BNP
brain natriuretic peptide
BOB
bronchiolitis obliterans
BODE
body mass, airflow obstruction, dyspnoea, and
exercise capacity
BSA
body surface area
BSLTx
bilateral sequential lung transplantation/
transplant
BUN
blood urea nitrogen
CABG
coronary artery bypass grafting
CAD
coronary artery disease
CAHPS
Consumer Assessment of Healthcare Providers
and Systems
CARS
compensatory anti-inflammatory response
syndrome


xiv

  abbreviations

CAV
CAVH
CAVHD
CAVHDF
CBC
CBIG
CCO
CDC
CESAR

cardiac allograft vasculopathy
continuous arteriovenous haemofiltration
continuous arteriovenous haemodialysis
continuous arteriovenous haemodiafiltration
complete blood count
catastrophic brain injury guideline
continuous cardiac output
Centers for Disease Control and Prevention
conventional ventilatory support versus
extracorporeal membrane oxygenation for severe
adult respiratory failure trial
CF
cystic fibrosis
CFTR
cystic fibrosis transmembrane conductance
regulator gene
cGMP
cyclic guanosine monophosphate
CHD
congenital heart disease
CHF
congestive heart failure
CIcardiac index
CIT
cold ischaemia time
CKD
chronic kidney disease
CM-AR
cell-mediated acute rejection
CMPcardiomyopathy
CMRO2
cerebral metabolic rate for oxygen
CMS
Centers for Medicare and Medicaid Services
CMVcytomegalovirus
CNI
calcineurin inhibitor
CNS
central nervous system
CNT
National Council of Transplantation
COcardiac output
COOLDonor Cooling to Optimize Organ Live in Donor Study
COPD
chronic obstructive pulmonary disease
CPAP
continuous positive airway pressure
CPBcardiopulmonary bypass
CPM
central pontine myelinolysis
CPP
cerebral perfusion pressure
CPX
cardiopulmonary exercise
CR
chronic rejection
Crcreatinine
CRBSI
catheter-related bloodstream infection
CRRT
continuous renal replacement therapy
CSFcerebrospinal fluid
CT
computed tomography
CTA
computed tomography angiography/angiogram
CTLA4-Ig cytotoxic T-lymphocyte antigen-4
immunoglobulin
CTPChild–Turcotte–Pugh
CUSUM
cumulative summation
CVcardiovascular
CVA
cerebrovascular accident
CVC
central venous catheter
CVD
cardiovascular disease
CVP
central venous pressure
CVVH
continuous venovenous haemofiltration
CVVHDF continuous venovenous haemodialysis and
filtration
CYP3A
cytochrome P-450 IIIA
DAD
diffuse alveolar damage
DBD
deceased brain donors
DCCT
Diabetes Control and Complications Trial

DCD
DCDD
DCM
DDAVP
DGF
DI
DIC
DIOS
DLA
DLCO

donation after circulatory death
donation after circulatory determination of death
dilated cardiomyopathy
1-desamino-8-D-arginine vasopressin
delayed graft function
diabetes insipidus
disseminated intravascular coagulation
distal intestinal obstruction syndrome
donor-specific antibodies
diffusing capacity of the lungs for carbon
monoxide
DLTx
double-lung transplantation/transplant
DMADV
define, measure, analyse, design, verify
DMAIC
define, measure, analyse, improve, control
DMG
donor management goal
DNDD
donation/donors after neurological determination
of death
DNR
do not resuscitate
DOB
delta over baseline
DPA
dorsal pancreatic artery
DRdonor–recipient
DRESS
drug-related eosinophilic syndrome
DRI
donor risk index
DSA
donor-specific antibodies
DSE
dobutamine stress echocardiography
DXR
delayed xenograft rejection
EASD
European Association for the Study of Diabetes
EASL
European Association for the Study of the Liver
EBMT
European Group for Blood and Marrow
Transplantation
EBS
European Board of Surgery
EBVEpstein–Barr virus
ECendothelial cell
ECD
expanded criteria donor
ECGelectrocardiography
ECHOechocardiography
ECHOT4
Evaluation of the Efficacy and Safety of
Levothyroxine in Brain Death Organ Donors: a
Randomized Controlled Trial
ECMO
extracorporeal membrane oxygenation
EC-MPA
enteric-coated mycophenolic acid
EEGelectroencephalography
EF
ejection fraction
EGDT
early goal-directed therapy
EHR
electronic health record
EJ
external jugular
ELITA
European Liver and Intestinal Transplant
Association
ELTR
European Liver Transplant Registry
EMBendomyocardial biopsy
EPTS
estimated post-transplant survival
ERCP
endoscopic retrograde cholangiopancreatography
ESA
European Society of Anaesthesiologists
ESDP
Eurotransplant Senior DR-compatible Program
ESLD
end-stage liver disease
ESOT
European Society of Organ Transplantation
ESP
Eurotransplant Senior Program
ESPEN
European Society for Clinical Nutrition and
Metabolism


 

ESRD
end-stage renal disease
EUEuropean Union
EVLP
ex-vivo lung perfusion
EVLWi
extravascular lung water index
FDA
Federal Drug Administration
FEV
forced expiratory volume
FFP
fresh frozen plasma
FGF-1
fibroblast growth factor-1
FIH
factor-inhibiting hypoxia-inducible factor
FiO2
fraction of inspired oxygen
FKBP
FK506 binding protein
FMS
Fluid Management System
FPG
fasting plasma glucose
FRC
functional residual capacity
FRETEP
Renal Graft Function After Treatment with
Erythropoetin
FSGS
focal segmental glomerulosclerosis
FSH
follicle-stimulating hormone
FTc
corrected flow time
FVC
forced vital capacity
GABAgamma-aminobutyric acid
GAD
glutamic acid decarboxylase
Galgalactose
GalTgalactosyltransferase
G-CSF
granulocyte-colony stimulating factor
GEDV
global end-diastolic volume
GFR
glomerular filtration rate
GIgastrointestinal
GJgastrojejunostomy
GORD
gastro-oesophageal reflux disease 
GVH
graft versus host
GVHD
graft versus host disease
H1N1
influenza A virus type H1N1
H-2histocompatibility 2
HAART
highly active antiviral therapy
HAR
hyperacute rejection
HAT
hepatic artery thrombosis
HAV
hepatitis A virus
Hbhaemoglobin
HBsAg
hepatitis B surface antigen
HBV
hepatitis B virus
HCAHPS
Hospital Consumer Assessment of Healthcare
Providers and Systems
HCC
hepatocellular carcinoma
HCM
hypertrophic cardiomyopathy
HCV
hepatitis C virus
HDhaemodialysis
hDAF
human decay accelerating factor
HDL
high-density lipoprotein
HE
hepatic encephalopathy
HELPP
haemolysis, elevated liver enzymes, and low
platelets
HEShydroxyethyl starch
HHS
Health and Human Services
HIFhypoxia-inducible factor
HIV
human immunodeficiency virus
HLA
human leucocyte antigen
HLHS
hypoplastic left heart syndrome
hMCP
human membrane cofactor protein

abbreviations

HOPE
HIV Organ Policy Equity
HPS
hepatopulmonary syndrome
HRCT
high-resolution computed tomography
HRQOL
Health-Related Quality of Life
HRS
hepatorenal syndrome
HRSA
Health Resources and Services Administration
HTKhistidine–tryptophan–ketoglutarate
HTNhypertension
HTx
heart transplantation/transplant
HU
high urgency
HVG
host versus graft
HXhypoxanthine
I/Rischaemia–reperfusion
IA-1
zinc finger protein IA-1
IABP
intra-aortic balloon pump
IAK
islet after kidney
IAP
intra-abdominal pressure
ICAM-1
intercellular adhesion molecule 1
ICGindocyanine green
ICP
intracranial pressure
ICS
intraoperative red blood cell salvage
ICT
intracardiac thrombosis
ICU
Intensive Care Unit
IDF
International Diabetes Federation
IEq
islet equivalents
IFG
impaired fasting glycaemia
IFN-γ³interferon-gamma
Igimmunoglobulin
IGT
impaired glucose tolerance
IHD
ischaemic heart disease
IJ
internal jugular
ILinterleukin
IL-2R
interleukin-2 receptor
ILTS
International Liver Transplantation Society
IMintramuscular
IMA
inferior mesenteric artery
IMPDH
inosine monophosphate dehydrogenase
IMPDH1
inosine 5-monophosphate dehydrogenase 1
IMV
inferior mesenteric vein
INCORT
National Institute of Transplant Coordination
INHisoniazid
iNO
inhaled nitric oxide
INOP
Iranian Network for Organ Procurement
INR
International Normalized Ratio
IoC
index of covariance
IPC
ischaemic preconditioning
IPF
initial poor function
IPF
idiopathic pulmonary fibrosis
IS
immunosuppressive regimens
ISCT
International Society for Cellular Therapy
ISHLT
International Society for Heart and Lung
Transplantation
ISO
International Organization for Standardization
ITA
islet transplant alone
ITBV
intrathoracic blood volume
ITBVi
intrathoracic blood volume index
ITCO
intermittent thermodilution cardiac output
ITx
intestinal transplantation/transplant
IVintravenous

xv


xvi

  abbreviations

IVC
inferior vena cava
IVIG
intravenous immunoglobulin
IVSinterventricular septum
JCV
John Cunningham virus
JDRFI
Juvenile Diabetes Research Foundation
International
J–Ejaundice–encephalopathy
JKTNW
Japan Kidney Transplant Network
JNK
c-Jun N-terminal kinase 
JOTNW
Japan Organ Transplant Network
KCC
King’s College Criteria
KOknockout
KTx
kidney transplantation
LAleft atrial
LAS
lung allocation score
LDlive donor
LDF
leucocyte depletion filter
LDL
low-density lipoprotein
LDLT
living donor liver transplantation
LFA-1
leucocyte function antigen
LFT
liver function test
LH
luteinizing hormone
LICAGE
Liver Intensive Care Group of Europe
LiMax
maximal enzymatic liver function capacity
LPD
low potassium dextran
LRD
living related donor
LTx
lung transplantation/transplant
LV
left ventricle
LVAD
left ventricular assist device
LVEDA
left ventricular end-diastolic area
LVEF
left ventricular ejection fraction
MA
maximum amplitude
MAC
minimum alveolar concentration
MACE
major adverse cardiac events
MAGE
mean amplitude of glycaemic excursions
MAP
mean systemic arterial pressure
MAPK
mitogen-activated protein kinase
MARS®
Molecular Adsorbent Recirculating System
Mbmegabase
MCA
middle cerebral artery
MCF
maximum clot firmness
MCP
membrane cofactor protein
MCT
medium chain triglycerides
MDRD
modification of diet in renal disease
MELD
Model for End-stage Liver Disease
MET
mean exercise tolerance
MGH
Massachusetts General Hospital
mHag
minor histocompatibility antigen
MHC
major histocompatibility complex
MI
myocardial infarction
MMF
mycophenolate mofetil
MMR
measles, mumps, and rubella
MMRC
Modified Medical Research Council
MMVTx
modified multivisceral transplantation/transplant
MOF
multi-organ failure
MPAmycophenolic acid
mPAP
mean pulmonary artery pressure
MPSC
Membership and Professional Standards
Committee

MPT
mitochondrial permeability transition
MPTP
mitochondrial permeability transition pore
MRA
magnetic resonance angiography/angiogram
MRI
magnetic resonance imaging
MRSA
methicillin-resistant Staphylococcus aureus
mTOR
mammalian target of rapamycin
MVTx
multivisceral transplantation/transplant
Nabs
natural antibodies
NACN-acetyl-cysteine
NADPH
nicotinamide adenine dinucleotide phosphate
NAFLD
non-alcoholic fatty liver disease
NASH
non-alcoholic steatohepatitis
NATCO
North American Transplant Coordinators
Organization
NF-κB
nuclear factor kappa-light-chain-enhancer of
activated B cells
NGSP
National Glycohemoglobin Standardization
Program
NHANES National Health and Nutrition
Examination Survey
NHBDnon-heart-beating donor
NHL
non-Hodgkin lymphoma
NHS
National Health Service
NICE
National Institute for Health and Clinical
Excellence
NIH
National Institutes of Health
NIRS
near-infrared spectroscopy
NIV
non-invasive ventilation
NKnatural killer
NKT
natural killer T
NMDAN-methyl-D-aspartate
n-NOS
nitric oxide synthetase
NO–nitric oxide
NOTA
National Organ Transplant Act
NPOnil per os
NQF
National Quality Forum
NSQIP
National Surgical Quality Improvement Program
NTPR
National Transplantation Pregnancy Registry
NVASRS
National Veterans Administration Surgical
Risk Study
NYHA
New York Heart Association
O:E
observed to expected
OGDoesophagogastroduodenoscopy
OGTT
oral glucose tolerance test
OH–
hydroxyl radical
OKT3muromonab-CD3
OLT
orthotropic liver transplantation
OLV
one-lung ventilation
ONT
Spanish National Transplant Organization
OONO–peroxynitrite
OPO
organ procurement organization
OPTN
Organ Procurement and Transplantation Network
ORoperating room
OTPD
organs transplanted per donor
P:FPaO2:FiO2 ratio
PApulmonary artery
PAC
pulmonary artery catheter
PACU
post-anaesthesia care unit
PAD
pulmonary artery diastolic pressure


 

PAFC
pulmonary artery flotation catheter
PAH
pulmonary artery hypertension
PAK
pancreas after kidney
PAKTx
pancreas after kidney transplantation/transplant
PaO2
arterial partial pressure of oxygen in arterial blood
PAOP
pulmonary arterial occlusion pressure
PAP
pulmonary artery pressure
PaCO2
partial pressure of carbon dioxide
PAT
pancreas alone transplant
PAWP
pulmonary artery wedge pressure
PBC
primary biliary cirrhosis
PBPC
peripheral blood progenitor cells
PCA
patient-controlled analgesia
PCI
percutaneous coronary intervention
PCMR
Pediatric Cardiomyopathy Registry
PCP
pneumocystis pneumonia
PCR
polymerase chain reaction
PCWP
pulmonary capillary wedge pressure
PD
peritoneal dialysis
PDF
primary liver dysfunction
PDGF
platelet-derived growth factor
PDK
pyruvate dehydrogenase kinase
PDSA
plan, do, study, act
PE
pulmonary embolus
PedsQL4.0 Pediatric Quality of Life Inventory 4.0
PEEP
positive end-expiratory pressure
PELD
paediatric end-stage liver disease
PERV
porcine endogenous retrovirus
PET
positron emission tomography
PFO
patent foramen oval
PGprostaglandin
PGD
primary graft dysfunction
PGNF
Primary Graft Non-Function
PHD
prolyl hydroxylase
PHT
pulmonary hypertension
PHTS
Pediatric Heart Transplant Study
PICC
percutaneous intravenous catheter
PICU
paediatric intensive care unit
Pinsp
inspiratory pressure
PIP
peak inspiratory pressure
PLE
protein-losing enteropathy
PML
progressive multifocal leucoencephalopathy
PN
parenteral nutrition
PNF
primary non-function
PNH
paroxysmal nocturnal haemoglobinuria
poper os
POC
point of care
POCD
postoperative cognitive dysfunction
PP
pancreatic polypeptide
P-PASS
preprocurement pancreas allocation
suitability score
PPH
primary pulmonary hypertension
PPHTN
portopulmonary hypertension
ppm
parts per million
PPV
pulse pressure variation
PRA
panel reactive antibody
PRBC
packed red blood cell
PRN
pro re nata
PRS
postreperfusion syndrome

abbreviations

PSE
portosystemic encephalopathy
PSRProgram-Specific Report
PTprothrombin time
PTFEpolytetrafluoroethylene
PTH
parathyroid hormone
PTLD
post-transplant lymphoproliferative disorder
PTT
partial thromboplastin time
PTxA
pancreas transplant alone
PV
pulmonary vein/venous
PVR
pulmonary vascular resistance
QALY
quality-adjusted life expectancy
qds
four times a day
QOL
quality of life
QOLI
quality of life index
RAright atrium
RAASrenin–angiotensin–aldosterone system
RAP
right atrial pressure
RBC
red blood cell
RCM
restrictive cardiomyopathy
RCPCH
Royal College of Paediatrics and Child Health
RCT
randomized clinical trial
RE
response entropy
RFLP
restriction fragment length polymorphism
RIPCOD
Remote Ischemic Preconditioning in Neurological
Death Organ Donors
RIPCOT
Remote Ischemic Preconditioning in Abdominal
Organ Transplantation
RIS
rapid infusion system
ROS
reactive oxygen species
ROTEM®
rotational thromboelastometry
RRT
renal replacement therapy
RV
right ventricle/ventricular
RVAD
right ventricular assist device
RVSP
right ventricular systolic pressure
SAsinoatrial
SAsplenic artery
SAC
standard acquisition charge
SAM
systolic anterior motion
SATA
Society for the Advancement of Transplant
Anesthesia
SBP
spontaneous bacterial peritonitis
SBS
short bowel syndrome
SCD
standard criteria donor
SCMsternocleidomastoid
SCUF
slow continuous ultrafiltration
ScvO2
central venous oxygen saturation
SE
state entropy
SEOPF
Southeast Organ Procurement Foundation
SEROPP
Southeastern Regional Organ Procurement
Program
SFSS
small-for-size syndrome
SIK
simultaneous islet–kidney
SIMV
synchronized intermittent mandatory ventilation
SIRS
systemic inflammatory response syndrome
SjO2
jugular bulb oxygen saturation
SjvO2
jugular venous oxygen saturation
SKPT
simultaneous kidney–pancreas transplant
SLA
swine leucocyte antigen
SLTx
single-lung transplantation/transplant

xvii


xviii

  abbreviations

SMA
SMV
SPAD®
SPECT
SPKTx

superior mesenteric artery
superior mesenteric vein
Single Pass Albumin Dialysis
single photon emission computed tomography
simultaneous pancreas–kidney transplantation/
transplant
SpO2
peripheral capillary oxygen saturation
SPRT
sequential probability ratio test
SREBP
sterol regulatory element binding protein
SRTR
Scientific Registry of Transplant Recipients
SVC
superior vena cava
SvO2
mixed venous oxygen saturation
SVR
systemic vascular resistance
SVV
stroke volume variation
T1DR
type 1 diabetes recurrence
T3tri-iodothyronine
T4thyroxin
TACO
transfusion-associated circulatory overload
TA-GVHD transfusion-associated graft versus host disease
TAP
transversus abdominis plane
TBtuberculosis
TCD
transcranial Doppler
TCR
Transplant Candidate Registration Form
TEA
thoracic epidural anaesthesia
TEB
transthoracic electrical bioimpedance
TED
thromboembolic deterrent
TEGthromboelastography/gram
TEM-AThromboElastoMeter-Automated
TGF-β
transforming growth factor β
TGH
Toronto General Hospital
THAMtris(hydroxymethyl)aminomethane
THAMtromethamine
TIA
transient ischaemic attack
TIPS
transjugular intrahepatic portosystemic shunt
TIVA
total intravenous anaesthesia
TMA
thrombotic microangiopathy
TNF
tumour necrosis factor
TOE
transoesophageal echocardiography
TOF/PA
tetralogy of Fallot with pulmonary atresia
TOR
target of rapamycin
TPE
therapeutic plasma exchange
TPG
transpulmonary gradient
TPM
Transplant Procurement Management
TPN
total parenteral nutrition

TRALI
transfusion-related acute lung injury
TRF
Transplant Recipient Follow-up Form
TRICC
Transfusion Requirements in Critical Care
TRIM
transfusion-related immunomodulation
TRR
Transplant Recipient Registration Form
TSH
thyroid-stimulating hormone
TTE
transthoracic echocardiogram
TTS
the Transplantation Society
UAGA
Uniform Anatomical Gift Act
UCLA
University of California, Los Angeles
UEMS
Union Européenne des Médecins Spécialistes
UFRultrafiltration rate
UIP
usual interstitial pneumonia
UKELD
United Kingdom Model for End-Stage Liver
Disease
UNOS
United Network for Organ Sharing
USRDS
US Renal Data System
UTI
urinary tract infection
UW
University of Wisconsin
VA
Veterans Administration
VAD
ventricular assist device
VA-ECMO venoarterial extracorporeal membrane
oxygenation
vCJD
variant Creutzfeldt–Jakob disease
VDAC
voltage-dependent anion channels
VEGF
vascular endothelial growth factor
VHA
viscoelastic haemostatic assay
VO2
peak oxygen consumption
VRE
vancomycin-resistant Enterococcus
VSD
ventricular septal defect
VT
ventricular tachycardia
VTE
venous thromboembolic
VVBvenovenous bypass
vWF
von Willebrand factor
WBC
white blood cell
WHO
World Health Organization
WIT
warm ischaemia time
WUWoods Units
XD
xanthine dehydrogenase
XO
xanthine oxidase
ZnT8
zinc transporter 8
α1ATalpha-1-antitrypsin
αFPalpha-fetoprotein
γGT
serum glutamyl transferase


Editors

Editor-in-Chief
Ernesto A. Pretto, Jr., MD, MPH
Professor and Chief
Division of Transplant and Vascular Anesthesia
Department of Anesthesiology, Perioperative Medicine and
Pain Management
Miami Transplant Institute
University of Miami
Leonard M. Miller School of Medicine/Jackson Memorial
Hospital
Miami
Florida
USA

Editors
Gianni Biancofiore, MD
Head Anestesia e Rianimazione SSN
Azienda Ospedaliera Pisana
Ospedale di Cisanello
Pisa
Italy

Andre De Wolf, MD
Professor of Anesthesiology
Director, Transplant Anesthesiology Service
Department of Anesthesiology
Feinberg School of Medicine
Northwestern University
Chicago
Illinois
USA

John R. Klinck, MD, FRCPC, FRCA
Consultant in Anaesthesia
Division of Perioperative Care
Cambridge University Hospitals
Cambridge
UK

Claus Niemann, MD
Professor of Anesthesia & Surgery
Department of Anesthesia and Perioperative Care
Department of Surgery, Division of Transplantation
University of California
San Francisco
California
USA

Andrew Watts, MD, FANZCA
Consultant in Anaesthesia
Head of Transplant Anaesthesia
Royal Prince Alfred Hospital
Sydney
Australia

Contributing Editor
Peter D. Slinger, MD, FRCPC
Associate Professor and Staff Anesthesiologist
Toronto General Hospital
University of Toronto
Toronto
Canada



Contributors

Luz Aguina

Kumar Belani

Fellow
Solid Organ Transplant and Vascular Anesthesia
University of Miami
Leonard M. Miller School of Medicine
Miami
Florida
USA

Professor of Anesthesiology
University of Minnesota
Minneapolis
Minnesota
USA

Gabriella Amorese
Division of General and Transplant Surgery and Division
of Anesthesia and Intensive Care
Cisanello University Hospital
Pisa
Italy

Faisal Anis
Transplant Anesthesia Fellow
Division of Solid Organ Transplant and Vascular Anesthesia
Department of Anesthesiology, Perioperative Medicine and
Pain Management
University of Miami
Leonard M. Miller School of Medicine/Jackson Memorial
Hospital
Miami
Florida
USA

Alan Ashworth
Consultant in Anaesthesia & ICU
University Hospital of South Manchester
Manchester
UK

Oliver Bagshaw
Consultant in Anaesthesia and Intensive Care
Birmingham Children’s Hospital
Birmingham
UK

James Bennett
Consultant Anaesthetist
Birmingham Children’s Hospital
Birmingham
UK

Gabriela A. Berlakovich
Medical University Vienna
Department of Surgery
Inerim. Head Division of Transplantation
Vienna
Austria

Gianni Biancofiore
Head Anestesia e Rianimazione SSN
Azienda Ospedaliera Pisana
Ospedale di Cisanello
Pisa
Italy

Martin Birch
Assistant Professor of Anesthesiology
University of Minnesota
Minneapolis
Minnesota
USA

Matthew B. Bloom
Trauma Surgery and Surgical Critical Care
Cedars-Sinai Medical Center
Los Angeles
California
USA


xxii

  contributors

Ugo Boggi

Maria Gabriella Costa

Professor of Surgery
Director of Kidney and Pancreas Transplantation Program
University School of Medicine
Pisa
Italy

Associate Professor of Anesthesiology and Critical Care
Medicine
Department of Anesthesia and Critical Care Medicine
University School of Medicine
Udine
Italy

Peter Bromley
Consultant Anaesthetist
Birmingham Children’s Hospital
Birmingham
UK

Daniel M. Bruggebrew
Donor Network
West California
USA

George Burke
Professor of Surgery, Chief
Division of Kidney and Kidney–Pancreas
University of Miami
Leonard M. Miller School of Medicine
Miami
Florida
USA

Marcelo Cypel
Assistant Professor of Surgery
University of Toronto and Toronto General Hospital
Toronto
Canada

Andrea De Gasperi
Director of Abdominal Transplant Anesthesia and Critical Care
Service 2, Ospedale Niguarda Ca' Granda
Milan
Italy

Kerry Gunn
Specialist Anaesthetist
Department of Anaesthesia and Perioperative Medicine
Auckland City Hospital
Auckland
New Zealand

Richard Charlewood

Giorgio Della Rocca

Transfusion Medicine Specialist
New Zealand Blood Service
Auckland
New Zealand

Professor of Anesthesiology and Critical Care Medicine
Department of Anesthesia and Critical Care Medicine
University School of Medicine
Udine
Italy

Linda Chen
Assistant Professor
DeWitt Daughtry Department of Surgery
Surgical Director, Liver Kidney Live Donor Program
Miami Transplant Institute
University of Miami
Leonard M. Miller School of Medicine/Jackson Memorial
Hospital
Miami
Florida
USA

Gaetano Ciancio
Professor of Surgery
Division of Kidney and Kidney–Pancreas
University of Miami
Leonard M. Miller School of Medicine
Miami
Florida
USA

M. Francesca Egidi
Professor of Nephrology Head, Department of Nephrology
University School of Medicine
Pisa
Italy

Obi Ekwenna
Assistant Professor of Urology and Transplantation
Department of Urology
University of Toledo Medical Center
Ohio
USA

Mazen Faden
Assistant Professor
Department of Anesthesia and Critical Care
King Abdulaziz
University Jeddah
Saudi Arabia


 

James Y. Findlay

Ryutaro Hirose

Associate Professor of Anesthesiology and Consultant
Department of Anesthesiology and Critical Care Medicine
Mayo Clinic
Rochester
Minnesota
USA

Professor in Clinical Surgery
Department of Surgery
Division of Transplantation
Associate Director
Surgical Residency Program
University of California
San Francisco
California
USA

Robin N. Fiore
Institute for Bioethics and Health Policy
University of Miami
Leonard M. Miller School of Medicine
Miami
Florida
USA

Haran Fisher
Assistant Professor
Division of Solid Organ Transplant and Vascular Anesthesia
Department of Anesthesiology, Perioperative Medicine and
Pain Management
University of Miami
Leonard M. Miller School of Medicine/Jackson Memorial
Hospital
Miami
Florida
USA
and
Department of Anaesthesia
Schneider Children’s Hospital
Tel Aviv
Israel

Kyota Fukazawa
Assistant Professor of Clinical Anesthesiology
Department of Anesthesiology
University of Miami
Leonard M. Miller School of Medicine
Miami
Florida
USA

Mark Hayman
Department of Anaesthesia
Royal Prince Alfred Hospital
Sydney
Australia

Benjamin E. Hippen
Metrolina Associates PA
Charlotte
North Carolina
USA

contributors

Katherine G. Hoctor
Voluntary Assistant Professor of Anesthesiology
University of Miami
Leonard M. Miller School of Medicine
Jackson Memorial Hospital
Miami
Florida
USA

Gyu-Sam Hwang
Department of Anesthesiology and Pain Medicine
Asan Medical Centre
University of Ulsan
Seoul
Korea

Anurag Johri
Department of Anesthesiology, Perioperative Medicine and
Pain Management
University of Miami
Leonard M. Miller School of Medicine/Jackson Memorial
Hospital
Miami
Florida
USA

Lydia M. Jorge
Assistant Professor of Pediatric Anesthesia
Department of Anesthesiology
University of Miami
Miami
Florida
USA

John R. Klinck
Consultant in Anaesthesia
Division of Perioperative Care
Cambridge University Hospitals
Cambridge
UK

xxiii


xxiv

  contributors

Michael C. Lewis

Nikole Neidlinger

Professor and Chairman
Department of Anesthesiology
University of Florida College of Medicine
Jacksonville
Florida
USA

Medical Director
Donor Network West
California
USA

Darren J. Malinoski
Assistant Chief of Surgery
Portland VA Medical Center
Associate Professor of Surgery
Oregon Health & Science University
Portland
Oregon
USA

Piero Marchetti
Associate Professor of Endocrinology and Metabolic Diseases
Director
Unit of Endocrinology and Cellular and Solid Organ
Transplantation Metabolism
University School of Medicine
Pisa
Italy

Jamie Lindemann Nelson
Professor of Philosophy
Associate Faculty
Center for Ethics and Humanities in the Life Science
Michigan State University
Michigan
USA

Claus Niemann
Professor of Anesthesia & Surgery
Department of Anesthesia and Perioperative Care
Department of Surgery, Division of Transplantation
University of California
San Francisco
California
USA

Seigo Nishida

Professor of Medicine and Director Division of Hepatology
University of Miami
Leonard M. Miller School of Medicine
Miami
Florida
USA

Professor of Clinical Surgery
DeWitt Daughtry Department of Surgery
Miami Transplant Institute
University of Miami
Leonard M. Miller School of Medicine/Jackson Memorial
Hospital
Miami
Florida
USA

Stuart Andrew McCluskey

Margherita Occhipinti

Department of Anesthesia and Pain Management
Toronto General Hospital
University of Toronto
Toronto
Canada

Department of Clinical and Experimental Medicine
Cisanello University Hospital
Pisa
Italy

Kirstin Naguit
Department of Anaesthesia
Concord Repatriation General Hospital
Sydney
Australia

Professor of Hepatology
Institute of Liver Sciences
King’s College Hospital
London
UK

Richard Neal

Andrea Olmos

Consultant in Intensive Care
Birmingham Children’s Hospital
Birmingham
UK

Department of Anesthesia and Perioperative Care
University of California
San Francisco
California
USA

Paul Martin

John O’Grady


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