2018 Clinical Update in Liver Transplantation

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.