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BACKGROUNDLiver transplant patients who develop hyperlactatemia are at increased risk of postoperative morbidity and mortality, but there are few data on longer-term outcomes. We therefore investigated whether arterial lactate concentration obtained immediately after surgery, at the time of admission to the intensive care unit (ICU), was associated with 1-year mortality. METHODS: In this retrospective cohort study, all patients who underwent liver transplant surgery between September 2013 and December 2019 were screened for inclusion. Patients who underwent combined transplantation surgery and those with a history of previous liver transplantation (i.e., redo surgery) were not included. Logistic regression modeling included univariate and multivariate analyses. Receiver operating characteristic (ROC) curves and areas under the curves (AUROCs) were calculated. Lactate thresholds and association with outcome were analyzed for specificity, sensitivity, and Youden’s index.RESULTS: Of 226 patients included, 18.4% died within 1-year of liver transplantation. Immediate postoperative lactate concentration was independently associated with 1-year mortality with an odds ratio (OR) of 1.35 (95% CI: 1.16 to 1.59; pCONCLUSION: Increased arterial lactate concentration on admission to the ICU immediately after orthotopic liver transplantation is independently associated with increased 1-year mortality.Trial Registration: Not Applicable

Background Placenta percreta is associated with high hemorrhagic risk and can be complicated with fatal thromboembolic events. Involving a multidisciplinary team in the treatment of these patients is mandatory to reduce morbidity and mortality. Case presentation This paper reports the case of a 22-year-old patient with placenta percreta who was referred to our tertiary care center for delivery. Few hours after undergoing a successful cesarean hysterectomy, the patient developed a pulmonary embolism and cardiac arrest. A transthoracic echocardiogram done in the intensive care unit (ICU) showed a thrombus in the right ventricle. After cardiac resuscitation, the patient underwent an urgent thoracotomy and a pulmonary artery thrombectomy; many clots were retrieved from the pulmonary artery. After weaning from extracorporeal circulation, an intraoperative transesophageal cardiac ultrasound enabled the medical team to detect a new free-floating thrombus in the right atrium and right ventricle, and consequently to perform an embolectomy and prevent the patient’s death. Conclusion This case emphasizes the role of multidisciplinary team in treating high-risk obstetric cases that could be complicated with massive and fatal thromboembolic events. The use of intraoperative transthoracic echocardiography helps in detecting a new thrombus and guides the anesthesiologist in the intra-operative monitoring.