[Liver transplantation--anesthesiology aspects].

Area of Science:

• Anesthesiology
• Transplant Surgery
• Hepatology

Context:

• Liver transplantation is a complex procedure with significant hemodynamic challenges.
• Perioperative anesthetic management is critical for patient outcomes.
• The absence of cardiopulmonary bypass alters hemodynamic profiles during liver transplantation.

Purpose:

• To describe the perioperative anesthetic management in 82 liver transplant procedures performed without a bypass technique.
• To present intra- and postoperative hemodynamic profiles of patients undergoing liver transplantation.
• To evaluate the effectiveness of preoperative plasma exchange in patients with severe coagulation defects.

Summary:

• Preoperative plasma exchange with fresh frozen plasma effectively improved prothrombin time in 16 patients with severe coagulation defects.
• Baseline hemodynamics revealed a hyperdynamic state (elevated cardiac index [CI] and heart rate).
• During the anhepatic phase, CI and mean arterial pressure (MAP) decreased. Reperfusion led to increased CI, moderate pulmonary artery pressure elevation, and a slow MAP recovery. Oxygen consumption index increased significantly post-reperfusion.

Impact:

• Provides insights into managing hemodynamics during non-bypass liver transplantation.
• Demonstrates the utility of plasma exchange for coagulopathy in liver transplant recipients.
• Contributes to optimizing anesthetic strategies for liver transplant surgery.