Intraoperative anaesthetic management of the liver transplant patient

Orthotopic liver transplantation has become an established method of treating end-stage liver disease. Anaesthesia for patients undergoing this procedure can be complicated because end-stage liver disease is often associated with dysfunction of other physiological systems. Rapid haemodynamic, metabolic and coagulation changes can occur intraoperatively requiring aggressive haemodynamic monitoring backed by on-line laboratory facilities. The increased understanding of the pathophysiology of the procedure and the use of dedicated rapid infusion systems and intraoperative blood salvage have helped to improve the intraoperative management of the liver transplant patient. Co-operation and communication between the blood bank, haematology, biochemistry, surgical and anaesthesia services are vital.