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Semin Respir Crit Care Med 2018; 39(05): 609-624
DOI: 10.1055/s-0038-1675333
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Perioperative Considerations in Liver Transplantation

Igor Barjaktarevic
1   Division of Pulmonary and Critical Care Medicine, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
,
Roxana Cortes Lopez
1   Division of Pulmonary and Critical Care Medicine, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
,
Randolph Steadman
2   Department of Anesthesia, UCLA David Geffen School of Medicine, Los Angeles, California
,
Christopher Wray
2   Department of Anesthesia, UCLA David Geffen School of Medicine, Los Angeles, California
,
Nida Qadir
1   Division of Pulmonary and Critical Care Medicine, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
,
Steven Y. Chang
1   Division of Pulmonary and Critical Care Medicine, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
,
Tisha Wang
1   Division of Pulmonary and Critical Care Medicine, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California
› Author Affiliations
Further Information

Publication History

Publication Date:
28 November 2018 (online)

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Abstract

Liver transplantation (LT) has the potential to cure patients with acute and chronic liver failure as well as a number of hepatic and biliary malignancies. Over time, due to the increasing demand for organs as well as improvements in the survival of LT recipients, patients awaiting LT have become sicker, and often undergo the procedure while critically ill. This trend has made the process of preoperative assessment and planning, intraoperative management, and postoperative management even more crucial to the success of LT programs. Multidisciplinary and specialized teams are essential and include anesthesiologists, surgeons, and intensivists. This article focuses on the preoperative evaluation, intraoperative care, and postoperative management of the liver transplant patient. Management relevant to the critically ill patient is discussed, with a focus on the management of postoperative cardiopulmonary conditions including the care of special populations such as those with hepatopulmonary syndrome and portopulmonary hypertension.

Keywords

liver transplantation - anesthesia - end-stage liver disease - postoperative critical care - hepatopulmonary syndrome - portopulmonary hypertension