2021 Clinical Update in Liver Transplantation

Area of Science:

• Anesthesiology
• Transplantation Medicine
• Hepatology

Background:

• Liver transplantation is a critical treatment for end-stage liver disease, with a 3.7% increase in procedures in 2021.
• The field of transplant anesthesiology is expanding, necessitating updated evidence-based practices.
• Advances in organ preservation technology offer potential for utilizing marginal organs and improving graft viability.

Purpose of the Study:

• To review current challenges and advancements relevant to anesthesiologists in liver transplantation.
• To highlight key areas including neurologic outcomes, obesity management, and hemostatic rebalancing.
• To emphasize the importance of monitoring and managing complex patient conditions during and after liver transplant.

Main Methods:

• Literature review of recent advancements in liver transplantation and anesthesiology.
• Analysis of challenges posed by end-stage liver disease sequelae, obesity, and nonalcoholic steatohepatitis.
• Discussion of hemostatic alterations, including bleeding and thrombosis risks.

Main Results:

• New organ preservation technologies may expand the donor pool and improve transplant success.
• Neurologic complications in liver transplant recipients require vigilant anesthetic management.
• Obesity and nonalcoholic steatohepatitis present significant comorbidity challenges in transplant candidates.
• Rebalanced hemostasis in end-stage liver disease necessitates awareness of both bleeding and thrombotic risks, including intracardiac thrombus.

Conclusions:

• Anesthesiologists play a vital role in managing complex patients undergoing liver transplantation.
• Continuous research and adaptation to new technologies and patient profiles are essential.
• Comprehensive understanding of neurologic, metabolic, and hemostatic issues is critical for optimal perioperative care and patient outcomes.