Critical Care Scenarios Episode 68: Liver transplant with Meera Gupta
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Dec 6, 2023 Dr. Meera Gupta, a transplant surgeon, discusses liver transplants, covering eligibility criteria, peri-operative care, and post-op complications. The podcast explores the importance of liver transplants, detailed patient evaluations, criteria challenges, organ allocation, surgery complexities, and ethical considerations in critical care scenarios.
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Comprehensive Pre-Transplant Workup
- Do perform a head-to-toe transplant evaluation including H&P, cardiac, pulmonary, abdominal imaging, and nutrition assessment.
- Involve hepatology, social work, dietitians, and pharmacists early to optimize pre-op readiness.
Hepatopulmonary Syndrome Mechanics
- Hepatopulmonary syndrome causes chronic intrapulmonary shunting that produces hypoxemia with slow onset.
- Patients may tolerate low saturations for long periods and need targeted testing like bubble echo and ABG baselines.
Optimize Kidneys And Nutrition Pre-Op
- Do assess kidney function and optimize renal support before transplant to reduce perioperative renal failure risk.
- Consider pre-habilitation like feeding tubes for severe malnutrition to improve postoperative healing.