Striking the Right Note: Assessing the Recipient for Liver Transplantation in Low- and Middle-Income Countries

Area of Science:

• Transplantation Medicine
• Anesthesiology
• Hepatology

Background:

• Liver transplantation has seen significant global growth, with over one million procedures performed.
• Deceased donor liver transplantation dominates in Europe/North America, while living donor or split liver transplantation is common in Asia.
• End-stage liver disease etiology and patient comorbidities vary significantly between developed and developing nations.

Purpose of the Study:

• To highlight essential aspects of perioperative assessment for liver transplant recipients.
• To emphasize the anesthesiologist's crucial role as a perioperative physician.
• To establish a standardized protocol for patient selection and optimization in liver transplantation.

Main Methods:

• Review of current practices in liver transplant recipient assessment.
• Analysis of the role of specific assessment tools.
• Development of a standardized perioperative assessment protocol.

Main Results:

• Identified a lack of standardization in perioperative assessment protocols for liver transplant recipients.
• Highlighted the anesthesiologist's comprehensive involvement from pre-operative workup to post-operative care.
• Emphasized the need for tailored assessments due to diverse patient comorbidities and etiologies of liver disease.

Conclusions:

• Standardized perioperative assessment protocols are essential for liver transplant recipients.
• Optimized patient selection and preparation can significantly reduce mortality and morbidity.
• Anesthesiologists are pivotal in developing and implementing these crucial protocols.