2020 Clinical Update in Liver Transplantation

Area of Science:

• Anesthesiology
• Hepatology
• Transplantation Medicine

Background:

• Liver transplantation (LT) is the gold standard for end-stage liver disease.
• LT patients present complex physiological challenges affecting multiple organ systems.
• Anesthetic management requires anticipating and mitigating these challenges.

Purpose of the Study:

• To highlight the multifaceted anesthetic considerations for liver transplant recipients.
• To discuss the impact of pre-transplant medications, surgical stress, and immunosuppression on perioperative care.
• To address the novel challenges posed by the COVID-19 pandemic to LT anesthesiology.

Main Methods:

• Review of anesthetic management strategies for end-stage liver disease patients undergoing LT.
• Analysis of physiological changes and potential complications in LT patients.
• Discussion of specific challenges including anticoagulation, pain management, glucose control, and pandemic-related issues.

Main Results:

• Anesthesiologists must navigate complex coagulopathy, often influenced by new anticoagulants.
• Effective pain management is crucial, balancing efficacy with opioid limitation.
• Perioperative glucose management is critical for patient and graft survival.
• The COVID-19 pandemic introduced unprecedented complexities for LT anesthesiologists.

Conclusions:

• Anesthetic care for LT is highly complex, demanding specialized expertise.
• Careful management of anticoagulation, pain, and glucose is paramount.
• Emerging infectious diseases, like COVID-19, necessitate adaptive anesthetic strategies for LT patients.