Assessing the risk of hyperkalemia with the use of normothermic machine perfusion during liver transplantation
Name:
Dr. Asad Bashir
Email
asad.bashir@ufl.edu
Phone
(352) 265-0077
Faculty Department/Division
Anesthesiology
This project is primarily:
Clinical
Research Project Description:
Introduction:
Normothermic machine perfusion (NMP) for rehabilitation of donor organ grafts received pre-market approval by the Food and Drug Administration (FDA) in 2021. In 2025, NMP received approval for use with air transport, allowing increased duration of use. These developments have led to increased use of the device to rehabilitate organs for transplantation, particularly liver transplantation.
At the University of Florida (UF), we are proud to have the highest patient and liver graft survival in the nation. We are the only center that has maintained this status for seven consecutive Scientific Registry for Transplant Recipients (SRTR) cycles. Since the approval for use of normothermic machine perfusion for rehabilitation of donor liver grafts, we have steadily increased the use of machine perfusion at UF.
Literature supports reduced risk of allograft dysfunction, improved organ viability assessment, extended preservation time, and improved outcomes for marginal grafts when donor livers are placed on normothermic machine perfusion devices. Due to the use of preservate solution and cell damage, hyperkalemia is often seen when organs are placed on machine perfusion.
Every organ discarded is a missed opportunity. With the significant shortages of organs and vast number of potential recipients, normothermic machine perfusion will continue to be utilized during organ transplantation in the future.
Aim:
This study aims to investigate the relationship between hyperkalemia and use of normothermic machine perfusion during liver transplantation. We will focus on levels of potassium obtained immediately after reperfusion of the donor graft. Key variables of interest will include Model for End Stage Liver Disease (MELD) score, donor status (DCD vs DBD), donor organ pathology report with a focus on steatosis, potassium levels post graft reperfusion.
Methods:
This retrospective cohort study with post hoc analysis will include all liver transplant surgeries performed at the University of Florida, Department of Anesthesiology, since the program’s inception to date. After IRB approval, de-identified patient data will be retrieved and analyzed. Data points will include MELD, donor type (DCD vs DBD), normothermic machine perfusion use prior to transplant, graft function variables, potassium levels post reperfusion.
Perioperative outcomes will be collected from the electronic patient file and the transplant surgery database. Specific analyses will include:
-Characterization of machine perfusion use during liver transplantation and its variability across cases.
-Correlation of machine perfusion use and hyperkalemia.
-Incidence of machine perfusion use during liver transplantation at UF Shands.
-Exploration of relationships between MELD scores and use of machine perfusion.
-Exploration of relationship of use of NMP and graft donor type (DCD vs DBD)
-Standard statistical models, including logistic regression and time-to-event analysis, will be used to assess these relationships.
Role of Medical Student:
-Data collection from electronic medical records (EMR).
-Assist with the extraction and organization of relevant variables.
-Participate in scientific writing for manuscript development and subsequent conference presentations.
-Gain exposure to clinical research methodologies and statistical analysis techniques.
Does this project have an international component or travel?
No
If your project has an international component please give details (where, when, data collection involved, etc.):
n/a
Incidence of early endotracheal extubation and its effectiveness in liver transplantation
Faculty Information
Name:
Dr. Asad Bashir
Email
asad.bashir@ufl.edu
Phone
(352) 265-0077
Faculty Department/Division
Liver transplanta anesthesiology
This project is primarily:
Clinical
Research Project Description:
Introduction:
Liver transplantation is a complex procedure often necessitating rapid transfusion of large volume blood products. The high-volume resuscitation along with case duration favor keeping the patient intubated while they recover post operatively and then extubating them in the intensive care unit (ICU). Certain liver transplant cases proceed uneventfully with minimal amount of blood product transfusion. These are usually low Model for End Stage Liver Disease (MELD) patients, who are younger and have fewer co-morbidities leading up to their transplant surgery.
Endotracheal intubation upon induction of anesthesia is a necessary component of general anesthesia during liver transplantation. Early extubation post procedure has been associated with lower pulmonary complications, improved hemodynamics, faster mobilization, decreased ICU stays and even improved graft function.
Aim:
This study aims to investigate the relationship between early extubation in liver transplant patients and MELD scores. Key variables of interest will include MELD score, AST, ALT, coagulation profile, bilirubin levels, use of normothermic machine perfusion for graft rehabilitation, type of donor (DCD vs DBD) and duration of intubation post procedure. Length of ICU stay will also be noted.
Methods:
This retrospective cohort study with post hoc analysis will include all liver transplant surgeries performed at the University of Florida, Department of Anesthesiology, since the program’s inception to date. After IRB approval, de-identified patient data will be retrieved and analyzed. Data points will include the key variables listed above.
Perioperative outcomes will be collected from the electronic patient file and the transplant surgery database. Specific analyses will include:
- Definition of early extubation
- Association of early extubation with MELD score
- Incidence of early extubation at UF Health Shands with regards to liver transplantation
- Corelation of early extubation and length of ICU stay
- Exploration of early extubation with graft function and hemodynamic status
-Standard statistical models, including logistic regression and time-to-event analysis, will be used to assess these relationships.
Role of Medical Student:
-Data collection from electronic medical records (EMR).
-Assist with the extraction and organization of relevant variables.
-Participate in scientific writing for manuscript development and subsequent conference presentations.
-Gain exposure to clinical research methodologies and statistical analysis techniques.
Does this project have an international component or travel?
No