The evolution of liver transplantation practices

Area of Science:

• Anesthesiology
• Hepatology
• Transplant Surgery

Background:

• Liver transplantation has advanced from a last resort to a sophisticated therapy with nearly 90% 1-year survival.
• Understanding the historical development of anesthetic perioperative care is essential for appreciating current practices.

Purpose of the Study:

• To review the evolution of anesthetic perioperative care in liver transplantation.
• To highlight the implications of this evolution on patient outcomes.

Main Methods:

• Review of historical anesthetic practices and recent advancements in liver transplantation.
• Analysis of evolving organ allocation policies and novel organ procurement strategies.

Main Results:

• Organ allocation policies are improving, incorporating better mortality predictors and increasing organ availability through donation after cardiac death and living donation.
• Advances in intraoperative hemostasis, blood loss management, renal physiology understanding, and early extubation protocols are enhancing patient outcomes.
• The evidence base for anesthetic perioperative care in liver transplantation is gradually expanding.

Conclusions:

• Evidence supporting perioperative best practices in liver transplantation remains limited.
• There is a critical need for more multicenter and international collaborative research to advance knowledge in this field.
• Improved understanding and research are vital for optimizing transplant outcomes.