Advances in the postoperative care of the liver transplant recipient

Survival rates following liver transplantation now exceed 90% at one year. However, the patient group undergoing liver transplantation is increasingly complex, requiring continued focus on improving perioperative care to sustain these survival outcomes. This review highlights recent advances in the postoperative care of the liver transplantation patient.

Modern care integrates Enhanced Recovery After Surgery (ERAS) principles, which emphasise early mobilisation and device minimisation. Risk stratification has become increasingly sophisticated, with frailty and cardiopulmonary exercise testing providing powerful prognostic information; emerging machine learning approaches may further refine personalised risk prediction.Goal-directed haemodynamic management is advocated, with restrictive fluid strategies and viscoelastic haemostatic assays to minimise transfusion. Advances in graft optimisation have expanded the donor pool: normothermic regional perfusion reduces ischaemic cholangiopathy in donation after cardiac death grafts, while machine perfusion systems show promise in improving early graft function.Advanced organ support (extracorporeal membrane oxygenation) requires careful graft-conscious management. Infection prevention strategies include tailored prophylaxis approaches. Nutrition and structured prehabilitation/rehabilitation programmes support recovery, reduce complications and address persistent functional deficits.

Collectively, these developments reflect a shift toward personalised, multidisciplinary postoperative care, aimed at improving both survival and quality of life for liver transplantation recipients.