Perioperative Considerations in Liver Transplantation

Abstract

Liver transplantation (LT) has the potential to cure patients with acute and chronic liver failure as well as a number of hepatic and biliary malignancies. Over time, due to the increasing demand for organs as well as improvements in the survival of LT recipients, patients awaiting LT have become sicker, and often undergo the procedure while critically ill. This trend has made the process of preoperative assessment and planning, intraoperative management, and postoperative management even more crucial to the success of LT programs. Multidisciplinary and specialized teams are essential and include anesthesiologists, surgeons, and intensivists. This article focuses on the preoperative evaluation, intraoperative care, and postoperative management of the liver transplant patient. Management relevant to the critically ill patient is discussed, with a focus on the management of postoperative cardiopulmonary conditions including the care of special populations such as those with hepatopulmonary syndrome and portopulmonary hypertension.

Tracheostomy in the Management of Pre-Operative Respiratory Failure in Liver Transplant Candidates

“…Recipients with higher MELD scores are more likely to develop pre-operative complications and have higher rates of ICU utilization and mechanical ventilation. Respiratory complications requiring mechanical ventilation are common among patients with ESLD, and recent studies suggest that preoperative respiratory failure is not a contraindication to OLT with proper patient selection [2][3].…”

Bicarbonate ringer’s solution could improve the intraoperative acid-base equilibrium and reduce hepatocellular enzyme levels after deceased donor liver transplantation: a randomized controlled study

“…Conventional orthotopic liver transplantation (OLT) is complicated and involves a high risk of acid-base imbalance and drastic haemodynamic fluctuations [ 1 ]. Heming [ 2 ] et al emphasized that the intravenous infusion of crystalloids is a key process to ensure tissue perfusion, cell oxygenation and physiological status in OLT patients.…”

Impact of Intraoperative Norepinephrine Support on Living Donor Liver Transplantation Outcomes: A Retrospective Cohort Study of 430 Children

“…It is the first-line agent to maintain end-organ perfusion pressure, especially in critically ill patients with low systemic vascular resistance. Many centers use it to minimize transfusion volume and fluid administration during the pre-anhepatic and anhepatic phase, and to reduce the occurrence of postreperfusion syndrome during the neohepatic phase of LT (Barjaktarevic et al, 2018). Previous studies have shown that NE-induced, b1-mediated increase in myocardial contractility played a crucial role in increasing the cardiac index of septic, postcardiotomy vasodilatory shock (Nygren et al, 2010;Redfors et al, 2011) and LT (Skytte Larsson et al, 2018) patients.…”