[Intensive care and perioperative monitoring in liver transplantation]

Perioperative intensive care has several objectives in the context of liver transplantation. Prior to the operation, it is essential for the management of fulminant hepatic failure in order to limit the consequences of cerebral oedema. During the operation, intensive care consists of monitoring and correction of the occasionally severe circulatory and metabolic disorders induced by vascular exclusion of the liver and revascularization of the cold, ischaemic, orthotopic transplant. The possibility of major haemorrhage requiring massive transfusion with stored blood aggravates these disorders. Complex clotting disorders also play an important role; their mechanism is imperfectly understood and they are difficult to control. The severity of the problems encountered after the operation depends on graft function.