The Edge of Unknown: Postoperative Critical Care in Liver Transplantation

Abstract

Perioperative care of patients undergoing liver transplantation (LT) is very complex. Metabolic derangements, hypothermia, coagulopathy and thromboses, severe infections, and graft dysfunction can affect outcomes. In this manuscript, we discuss several perioperative problems that can be encountered in LT recipients. The authors present the most up-to-date information regarding predicting and treating hemodynamic instability, coagulation monitoring and management, postoperative ventilation strategies and early extubation, management of infections, and ESLD-related pulmonary complications. In addition, early post-transplant allograft dysfunction will be discussed.

A Comprehensive Review of the Diagnosis and Management of Acute Liver Failure

“…It is advisable to opt for a viscoelastic-test-guided (thrombelastography or rotational thromboelastometry) approach using coagulation factors such as fibrinogen concentrate or prothrombin complex concentrate (PCC). This is preferable over the use of FFP and cryoprecipitate, based on recent findings [33]. Notably, FFP is linked with transfusion-related acute lung injury/transfusion-associated circulatory overload risks and potential infections, and similar concerns arise with cryoprecipitate [34].…”