Organ transplantation and drug eluting stents: Perioperative challenges

Core Tip

Core tip: Patients undergoing transplant surgery soon after the placement of drug eluting stents (DES) are at increased risk of stent thrombosis (ST) in the perioperative period. Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is instated post stenting to decrease the incident of ST. Cadaveric organ availability is unpredictable, therefore, discontinuation of antiplatelet medication cannot be optimally timed. Many platelet function point of care tests are used to assess bleeding risk and guide perioperative platelet transfusion. Response to allogenic platelet transfusion to control severe intraoperative bleeding may differ with the antiplatelet drug. DES are now used for endovascular interventions for post-transplant orthotropic heart coronary artery disease, hepatic artery stenosis post liver transplantation, etc. Antiproliferative drugs used in DES are also used for post-transplant immunosuppression.