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P7.02 Implementation of a tight control of blood pressure improve postoperative outcomes in children receiving liver transplantation

Mihaela A Damian, United States

Division of Pediatric Critical Care Medicine
Stanford University


As a pediatric intensivist, I have developed several areas of interest related to my clinical expertise in managing complex patients, particularly pediatric abdominal organ transplant recipients.  These interests range from my clinical care and teaching focus, to administrative and scholarly efforts  to enhance quality and safety for pediatric patients in the perioperative arena. I contribute the perspective of the intensivist with regard to perioperative concerns that allows for planning and optimization of these patients for transplantation 

I have very diverse research interests such as: pharmacokinetics of after liver transplant, perioperative outcomes, use of mechanical support  for transplant recipients.  

As part of my education role, in collaboration with my nursing colleagues  developed the pediatric solid organ transplantation curriculum for PICU nursing: Liver transplantation: development of bedside nursing skills curriculum that complies with UNOS requirements simulation for liver transplant.

I am very excited to be elected to the ethics and Allied Health and Nursing Professionals committees of the International Pediatric Transplant Association. 

            My aim is to contribute to the Stanford community and the field of pediatric critical care medicine as a leader in perioperative quality and safety and a clinical expert in pediatric liver and kidney transplantation.


Implementation of a tight control of blood pressure improve postoperative outcomes in children receiving liver transplantation

Mihaela Damian1, Laura Blair1, Jeffery Moss1, Andrew Bohham2.

1Division of Pediatric Critical Care, , Stanford UNiversity, Palo Alto, CA, United States; 2Division of Abdominal Transplantation, Department of Surgery, , Stanford University, Palo Alto, CA, United States

Introduction:  Pediatric liver transplantation is associated with signifficant morbidity. Over 500 pediatric orthotopic liver transplants (pOLT) are performed in the United States every year. arterial hypertension can occur in the immidiate postoperative period due to multiple factors such as fluid overload, pain, medications or kidney disease. Unless treated, hypertension could lead to complications such as poor perfusion of the graft, surgical bleeding or cerebral ischemia or bleeding.
Methods: Clinical guidelines for medical treatment of postoperative hypertension after pOLT were developed and implemented. Per protocol (fig 1) any patient that developed blood pressure higher then the established goal for age and did not resolved after treating any possible underlying causes such as pain, fluid overload were initiated on a continuous infusion according with the protocol. The aim of this project was to initiate treatment as soon as the diagnosis was made and to transition to oral medications within 2 days from diagnosis. All patients less than 18 years old without a prior diagnosis of arterial hypertension were included and the two groups (pre and post implementations were analized.
Results:  76 % (19/25)   pre-protocol versus 45 % (13/29) patients in the post-protocol period were diagnosed with hypertension. The median time of infusion was decreased from 3 days to 2.25 days while the time od transisioning from an infusion to oral medicatios was decrease to 0.9 days from 1.44 days. 17/19 pre-protocol and 8 of 13 patient post protocol that were diagnosed with hypertension were discharged home on oral antuhypertensive medications.(fig 2)  There were no complications such as hypotension, surgical bleeding, ischemia or strokes.
Conclusions: Arterial hypertension is common in the immediated postoperative periaod in children receiving pOLT. Appropiate treatment is safe and it could potentially reduce morbidities in this patient population.