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Liver transplant and impact on cerebral autoregulation: a systematic scoping review

Tommaso Rochat1, Artida Ulaj1, Frederic Sangla1

  • 1University Hospitals of Geneva, Geneva, Switzerland.

Frontiers in Transplantation
|February 4, 2026
PubMed

Insights

Cerebral autoregulation (CA) monitoring during liver transplants is inconsistent, particularly in acute liver failure. More standardized research is needed to understand its impact on brain blood flow and patient outcomes.

Area of Science:

  • Neurology
  • Transplantation Medicine
  • Critical Care

Background:

  • Cerebral autoregulation (CA), the brain's ability to maintain stable cerebral blood flow (CBF) despite mean arterial pressure (MAP) changes, may be disrupted during orthotopic liver transplantation (OLT).
  • Profound metabolic, inflammatory, and hemodynamic shifts during OLT can impair CA, risking cerebral hypoperfusion or hyperemia.
  • The perioperative evolution and clinical significance of impaired CA during OLT are not well understood.

Purpose of the Study:

  • To systematically review and synthesize existing evidence on cerebral autoregulation monitoring during OLT.
  • To identify methodological limitations and potential clinical applications of CA monitoring in OLT patients.

Main Methods:

  • A systematic scoping review adhering to Joanna Briggs Institute (JBI) guidelines.
  • Searched PubMed, Embase, Scopus, Web of Science, and Medline for studies assessing perioperative CA in adult OLT patients.
  • Included six studies (n=99) that quantitatively assessed CA.

Main Results:

  • Diverse methods (TCD, NIRS, PRx, Mx, COx, SCAI, TFA) were used to assess CA, with significant variation in monitoring phases and impairment definitions.
  • CA was often impaired pre-transplant and improved postoperatively in acute liver failure, but findings in chronic liver disease were inconsistent.
  • Few studies explored CA's association with neurological outcomes, yielding inconclusive results.

Conclusions:

  • Cerebral autoregulation is dynamically altered during OLT, especially in acute liver failure, but current evidence is limited by heterogeneity and small sample sizes.
  • Standardized, prospective studies are required to clarify the role of CA monitoring.
  • Further research should investigate if individualized blood pressure management guided by CA monitoring can improve neurological outcomes.
Abstract

Keywords:
cerebral autoregulationhemodynamic managementliver transplantationorthotopic liver transplantperioperative monitoring

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