Enhanced recovery after surgery in liver transplantation: the anesthesia perspective

Enhanced recovery after surgery (ERAS) has been introduced as a comprehensive strategy in liver transplantation (LT) in recent years. Guidelines for ERAS in LT are now available and embrace several domains of patient management. The transplant anesthesiologist is called into action through the entire process with particular attention to the maintenance of intraoperative homeostasis, early weaning and discontinuation of invasiveness, and pain control as main determinants of patient well-being.

Advanced hemodynamic monitoring and early extubation are established cornerstones of ERAS in LT. There are great expectations for the contribution of regional anesthesia and multimodal analgesia for a comfortable recovery but data are still limited. Leading centers in ERAS have reached considerable results and should serve as a reference for groups starting new programs. Differences in patient listing and prioritization significantly affect patient's conditions and should be accounted for. ERAS in LT will necessarily confront with the advent of mini-invasive surgery (robotic transplantation) in the next years, requiring a flexible approach.

ERAS is a rapidly growing opportunity in the complex setting of LT. Anesthesiologists play a crucial role in several important steps of the process and they are called to give their contribution in terms of vision and further evidences.