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Unexplained and prolonged perioperative hypotension after orthotopic liver transplantation: Undiagnosed systemic mastocytosis
Author(s) -
Willingham Darrin L.,
Peiris Prith,
Canabal Juan M.,
Krishna Murli,
Hewitt Winston R.,
Shine Timothy S. J.,
Arasi Lisa C.,
ArandaMichel Jaime,
Hughes Christopher B.,
Kramer David J.
Publication year - 2009
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21762
Subject(s) - medicine , systemic mastocytosis , liver transplantation , perioperative , orthotopic liver transplantation , anesthesia , transplantation , intensive care medicine , bone marrow
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. Liver Transpl 15:701–708, 2009. © 2009 AASLD.