Review of anesthesia in liver transplantation

Abstract

Liver transplantation (LT) is a well-accepted treatment modality of many end-stage liver diseases. The main issue in LT is the shortage of deceased donors to accommodate the needs of patients waiting for such transplants. Live donors have tremendously increased the pool of available liver grafts, especially in countries where deceased donors are not common. The main ethical concern of this procedure is the safety of healthy donors, who undergo a major abdominal surgery not for their own health, but to help cure others. The first part of the review concentrates on live donor selection, preanesthetic evaluation, and intraoperative anesthetic care for living liver donors. The second part reviews patient evaluation, intraoperative anesthesia monitoring, and fluid management of the recipient. This review provides up-to-date information to help improve the quality of anesthesia, and contribute to the success of LT and increase the long-term survival of the recipients.

Comparison of bispectral index targeted end-tidal concentration of desflurane during three phases of orthotopic liver transplantation

“…Temperature regulation and haemodynamic management are the two important non-disease physiological factors which can impact anaesthetic requirements in patients undergoing LD-OLT. [ 18 19 ] During LD-OLT, while acute hypotension is not uncommon owing to sudden massive bleeding and a low SVR;[ 20 ] difficult-to-manage hypothermia occurs because of the nature of surgery (prolonged, open, abdominal) and the iatrogenic effect of a cold preserved graft. [ 21 ] In our study, MAP was comparable across the three phases of surgery with pressure remaining above 75 mm Hg and no correlation was found between MAP and end- tidal desflurane concentration.…”

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“…The anesthesiologist plays an important role, by providing safe general anesthesia, maintaining an acceptable hemodynamic profile and ensuring sufficient perfusion to the vital organs of the patient. 15 In this case report, we present the anesthesia care of a 22-year-old patient with PH type 1 who had deceased cadaveric donor CLKT. Complications can be prevented or decreased when proper anesthesia management during surgery for CLKT is used.…”

Living Donor Liver Transplantation for Hepatocellular Carcinoma

“…Surgical outcome largely affects survival and hence final outcome. Early postoperative vascular complications are the main reasons of graft loss and in-hospital mortality and must be managed vigorously [49,[61][62][63][64].…”