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Fatal diffuse pulmonary fat microemboli following reperfusion in liver transplantation with the use of marginal steatotic allografts
Author(s) -
Rosenfeld David M.,
Smith Maxwell L.,
Seamans David P.,
Giorgakis Emmanouil,
Gaitan Brantley D.,
Khurmi Narjeet,
Aqel Bashar A.,
Reddy Kunam S.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15399
Subject(s) - medicine , steatosis , liver transplantation , transplantation , perioperative , economic shortage , reperfusion injury , lung , organ transplantation , surgery , ischemia , linguistics , philosophy , government (linguistics)
Organ shortage is a major cause of delayed liver transplantation and increased waitlist time. The level of donor steatosis is a significant determinant in organ selection. Scarcity of organs has led some programs to expand their acceptable criteria for the percentage of steatosis. We report two cases of liver transplantation of steatotic donor organs that resulted in mortality within hours from transplantation. Postmortem analysis showed evidence of diffuse pulmonary fat microemboli likely originating from the donor organ, with marked preservation reperfusion injury. The mechanism of diffuse fat microemboli in this setting and possible relationship to other perioperative syndromes (transfusion‐related lung injury, acute kidney injury, and postreperfusion syndrome) is discussed.