<abstract xmlns="http://www.w3.org/1999/xhtml"><p>Liver transplantation (LT) is a challenging surgery performed on patients with complex physiology profiles, complicated by multi-system dysfunction. It represents the treatment of choice for end-stage liver disease. The procedure is performed under general anaesthesia, and a successful procedure requires an excellent understanding of the patho-physiology of liver failure and its implications. Despite advances in knowledge and technical skills and innovations in immunosuppression, the anaesthetic management for LT can be complicated and represent a real challenge. Monitoring devices offer crucial information for the successful management of patients. Hemodynamic instability is typical during surgery, requiring sophisticated invasive monitoring. Arterial pulse contour analysis and thermo-dilution techniques (PiCCO), rotational thromboelastometry (RO-TEM), transcranial doppler (TCD), trans-oesophageal echocardiography (TEE) and bispectral index (BIS) have been proven to be reliable monitoring techniques playing a significant role in decision making. Anaesthetic management is specific according to the three critical phases of surgery: pre-anhepatic, anhepatic and neo-hepatic phase. Surgical techniques such as total or partial clamping of the inferior vena cava (IVC), use of venovenous bypass (VVBP) or portocaval shunts have a significant impact on cardiovascular stability. Post reperfusion syndrome (PRS) is a significant event and can lead to arrhythmias and even cardiac arrest.</p></abstract>

Liver transplantation (LT) is a challenging surgery performed on patients with complex physiology profiles, complicated by multi-system dysfunction. It represents the treatment of choice for end-stage liver disease. The procedure is performed under general anaesthesia, and a successful procedure requires an excellent understanding of the patho-physiology of liver failure and its implications. Despite advances in knowledge and technical skills and innovations in immunosuppression, the anaesthetic management for LT can be complicated and represent a real challenge. Monitoring devices offer crucial information for the successful management of patients. Hemodynamic instability is typical during surgery, requiring sophisticated invasive monitoring. Arterial pulse contour analysis and thermo-dilution techniques (PiCCO), rotational thromboelastometry (RO-TEM), transcranial doppler (TCD), trans-oesophageal echocardiography (TEE) and bispectral index (BIS) have been proven to be reliable monitoring techniques playing a significant role in decision making. Anaesthetic management is specific according to the three critical phases of surgery: pre-anhepatic, anhepatic and neo-hepatic phase. Surgical techniques such as total or partial clamping of the inferior vena cava (IVC), use of venovenous bypass (VVBP) or portocaval shunts have a significant impact on cardiovascular stability. Post reperfusion syndrome (PRS) is a significant event and can lead to arrhythmias and even cardiac arrest.

Anaesthesia for Liver Transplantation: An Update

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

{"article-title":"Anaesthesia for Liver Transplantation: An Update"}

Liver transplantation (LT) is a challenging surgery performed on patients with complex physiology profiles, complicated by multi-system dysfunction. It...

Class	Disease
Non-cholestatic liver disease	HepatitisB
	HepatitisC
	HepatitisD
	HepatitisA
	Alcoholic liver disease
	Autoimmune hepatitis
	Cryptogenic cirrhosis
	Non-alcoholic steatohepatitis
	Other

Cholestatic liver disease	Primary biliary cirrhosis
	Secondary biliary cirrhosis (Caroli disease, choledochal cyst)
	Primary sclerosing cholangitis
	Other

Malignant disease	Hepatocellular carcinoma
	Cholangiocarcinoma
	Hepatoblastoma
	Other

Extrahepatic biliary atresia or hypoplasia	Alagille syndrome
	Other

Metabolic diseases	Alpha-1 antitrypsin deficiency
	Crigler-Najjar disease, Type I
	Byler’s disease
	Glycogen storage disease, Type I
	Wilson’s disease
	Hemochromatosis
	Tyrosinemia
	Wolman’s disease
	Familial amyloidotic polyneuropathy
	Primary hyperoxaluria type 1
	Other

Hepatic vein thrombosis	Budd-Chiari

Acute hepatic failure	Hepatitis
	Drugs
	Unknown aetiology

Re-transplantation	Primary non-function
	Hepatic artery thrombosis
	Acute/chronic rejection

Anaesthesia for Liver Transplantation: An Update

Article Category: Case Report

Published Online: May 06, 2020

Page range: 91 - 100

Received: Aug 25, 2019

Accepted: Jan 30, 2020

DOI: https://doi.org/10.2478/jccm-2020-0011

Keywords
liver transplantation, haemodynamic monitoring, post-reperfusion syndrome

© 2020 Lavinia Nicoleta Brezeanu, Radu Constantin Brezeanu, Mircea Diculescu, Gabriela Droc, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Indications for liver transplantation

Anaesthesia for Liver Transplantation: An Update

Article Category: Case Report

Published Online: May 06, 2020

Page range: 91 - 100

Received: Aug 25, 2019

Accepted: Jan 30, 2020

DOI: https://doi.org/10.2478/jccm-2020-0011

Keywordsliver transplantation, haemodynamic monitoring, post-reperfusion syndrome

© 2020 Lavinia Nicoleta Brezeanu, Radu Constantin Brezeanu, Mircea Diculescu, Gabriela Droc, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Indications for liver transplantation

Keywords
liver transplantation, haemodynamic monitoring, post-reperfusion syndrome