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Opportunities for Salvage for Optimizing Ideal Outcomes

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Solid Organ Transplantation in Infants and Children

Part of the book series: Organ and Tissue Transplantation ((OTT))

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Abstract

In order to optimize outcomes following pediatric liver transplantation, clinicians must take a dual approach: (1) to prevent complications and (2) to successfully salvage patients after complications occur. In this chapter, the latter is addressed through understanding the utility of “failure to rescue” in perioperative quality improvement and specific strategies to address the most common complications in this population. Failure to rescue, a measure of a center’s ability to recognize quickly and effectively manage complications, is defined as mortality following a severe complication, and there is an increasing evidence to suggest its importance in efforts to improve outcomes following major surgery. The core tenets of successful rescue include early diagnosis and effective rescue. Hospital-level factors including team structure and communication and access to resources such as intensive care units and emergency operating rooms are essential to the ability to salvage a patient following complications. Strategies to enhance these aspects are discussed for common and morbid complications following this operation, including vascular complications, biliary tract complications, graft failure, and sepsis. By addressing the period after a complication occurs, clinicians can address disparities in the ability to rescue pediatric liver transplant patients and intervene on a period critical to optimizing outcomes.

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Authors and Affiliations

  1. University of Michigan Health Systems, Ann Arbor, MI, USA

    Shannon L. Cramm, Michael J. Englesbe & John C. Magee

Authors
  1. Shannon L. Cramm
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  2. Michael J. Englesbe
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  3. John C. Magee
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Corresponding authors

Correspondence to Shannon L. Cramm , Michael J. Englesbe or John C. Magee .

Editor information

Editors and Affiliations

  1. Department of Surgery, Jefferson Medical College, Wilmington, Delaware, USA

    Stephen P. Dunn

  2. Division of Gastroenterology, Seattle Children’s Hospital, Seattle, Washington, USA

    Simon Horslen

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Cramm, S.L., Englesbe, M.J., Magee, J.C. (2018). Opportunities for Salvage for Optimizing Ideal Outcomes. In: Dunn, S., Horslen, S. (eds) Solid Organ Transplantation in Infants and Children. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-07284-5_13

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  • DOI: https://doi.org/10.1007/978-3-319-07284-5_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-07283-8

  • Online ISBN: 978-3-319-07284-5

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