2018 Clinical Update in Liver Transplantation
Related Experiment Video
Updated: Jan 28, 2026
Liver Cold Storage and Transplantation in the Cold-Adaptive Daurian Ground Squirrels
Published on: July 3, 2025
Nicholas W Markin1, Kyle J Ringenberg1, Cale A Kassel1
1Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
Insights
Liver transplantation (LT) is crucial for end-stage liver disease. Anesthesiologists must manage hemodynamic and metabolic issues, including clotting and cardiac problems, for successful outcomes.
Area of Science:
- Anesthesiology
- Hepatology
- Transplant Surgery
Background:
- End-stage liver disease (ESLD) presents complex challenges for anesthesiologists during liver transplantation (LT).
- ESLD causes significant hemodynamic and metabolic derangements, impacting clotting and cardiac function.
- Cirrhotic cardiomyopathy can be masked and exacerbated by LT.
Purpose of the Study:
- To review organ system dysfunction in liver cirrhosis and its implications for LT.
- To discuss recent advances in the pathophysiology and treatment of liver cirrhosis.
- To highlight enhanced recovery after surgery (ERAS) protocols for LT patients and advances in organ preservation.
Main Methods:
- Review of current literature on liver cirrhosis, LT, and anesthesiology.
- Analysis of organ system derangements and their management.
- Discussion of recent advancements in pathophysiology, treatment, ERAS, and organ preservation.
Main Results:
- Successful LT requires anesthesiologists to manage complex hemodynamic and metabolic disturbances.
- Transesophageal echocardiography (TEE) is widely used (95%) in LT, with guidelines supporting its use even with esophageal varices.
- Recent advances focus on understanding pathophysiology, optimizing treatments, implementing ERAS, and improving organ preservation.
Conclusions:
- Anesthesiology in LT demands expertise in managing multifaceted organ system dysfunctions.
- TEE is a valuable tool in LT, with safety considerations for specific patient conditions.
- Integrated approaches including ERAS and optimized organ preservation are advancing LT outcomes.
Abstract:
Liver transplantation (LT) continues to be the gold standard for treating end-stage liver disease, and challenges that are posed to the anesthesiologist during transplantation are well known. Successful liver transplantation requires knowledge, recognition, and treatment of hemodynamic and metabolic disturbances by the anesthesiologist. End-stage liver disease causes unique derangements to the clotting cascade, increasing risk both for hemorrhagic and thrombotic events. Cirrhotic cardiomyopathy may be masked for years because of low systemic vascular resistance in cirrhosis, and overt heart failure can be precipitated by LT. Surveys of high-volume transplant centers show an overall transesophageal echocardiography (TEE) use rate of 95%. Guidelines on the use of TEE in LT have mirrored safety findings in several studies and suggest TEE may be used for patients with esophageal varices if the benefit outweighs the risk. This review will cover organ system dysfunction in liver cirrhosis and the implications for liver cirrhosis patients and review recent advances in pathophysiology and treatments. In addition, the authors will highlight the concept of enhanced recovery after surgery and how it pertains to the LT patient population. Lastly, the authors review recent advances in organ preservation and optimization.
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