[Anesthesiological Aspects of Liver Transplantation]

Overview

Journal Anaesthesist

Specialty Anesthesiology

Date 2019 May 4

PMID 31049602

Authors

S Dehne

F Lund

J Larmann

K Schmidt

T Brenner

M A Weigand

R von Haken

Affiliations

Soon will be listed here.

Abstract

Liver transplantation (LTPL) is the only curative option for patients with end stage liver disease (ESLD) or with hepatocellular carcinoma (HCC). Eurotransplant in Leiden, the Netherlands, is responsible for organ allocation. The model of end stage liver disease (MELD) score, which describes the severity of the liver disease, is decisive for organ allocation. The heterogeneous patient collective and hepatic-related comorbidities and their dynamics represent challenges. The anesthesiologist is responsible for evaluating the overall prognosis, whereby cardiac, pulmonary, renal and neurological comorbidities must be taken into consideration. During LTPL surgery is divided into several stages. Besides volume management, heat preservation and coagulation management, major challenges for the anesthesiologist are hemodynamic stabilization and regulation of the acid-base balance.

References

Wiest R, Lock G, Scholmerich J . [Portal hypertension]. Internist (Berl). 2000; 41(10):1077-95; quiz 1095. DOI: 10.1007/s001080050666. View

Neuberger J, Ubel P . Finding a place for public preferences in liver allocation decisions. Transplantation. 2000; 70(10):1411-3. DOI: 10.1097/00007890-200011270-00001. View

Glanemann M, Langrehr J, Kaisers U, Schenk R, Muller A, Stange B . Postoperative tracheal extubation after orthotopic liver transplantation. Acta Anaesthesiol Scand. 2001; 45(3):333-9. DOI: 10.1034/j.1399-6576.2001.045003333.x. View

Zink W, Graf B . [The pulmonary artery catheter]. Anaesthesist. 2001; 50(8):623-42; quiz 643-5. DOI: 10.1007/s001010100179. View

Rex S, Busch T, Vettelschoss M, de Rossi L, Rossaint R, Buhre W . Intraoperative management of severe pulmonary hypertension during cardiac surgery with inhaled iloprost. Anesthesiology. 2003; 99(3):745-7. DOI: 10.1097/00000542-200309000-00033. View

Freeman Jr R, Gish R, Harper A, Davis G, Vierling J, Lieblein L . Model for end-stage liver disease (MELD) exception guidelines: results and recommendations from the MELD Exception Study Group and Conference (MESSAGE) for the approval of patients who need liver transplantation with diseases not considered by the.... Liver Transpl. 2006; 12(12 Suppl 3):S128-36. DOI: 10.1002/lt.20979. View

Russell D, Flood A, Zaroda T, Acosta C, Riley M, Busuttil R . Outcomes of colonization with MRSA and VRE among liver transplant candidates and recipients. Am J Transplant. 2008; 8(8):1737-43. DOI: 10.1111/j.1600-6143.2008.02304.x. View

Gines P, Guevara M . Hyponatremia in cirrhosis: pathogenesis, clinical significance, and management. Hepatology. 2008; 48(3):1002-10. DOI: 10.1002/hep.22418. View

Rybak D, Fallon M, Krowka M, Brown Jr R, Reinen J, Stadheim L . Risk factors and impact of chronic obstructive pulmonary disease in candidates for liver transplantation. Liver Transpl. 2008; 14(9):1357-65. PMC: 2823393. DOI: 10.1002/lt.21545. View

10.

Solomkin J, Mazuski J, Bradley J, Rodvold K, Goldstein E, Baron E . Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2009; 50(2):133-64. DOI: 10.1086/649554. View

11.

Al-Hamoudi W . Cardiovascular changes in cirrhosis: pathogenesis and clinical implications. Saudi J Gastroenterol. 2010; 16(3):145-53. PMC: 3003209. DOI: 10.4103/1319-3767.65181. View

12.

Wang S, Shieh J, Chang K, Chu Y, Liu C, Loong C . Thromboelastography-guided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: randomized clinical trial. Transplant Proc. 2010; 42(7):2590-3. DOI: 10.1016/j.transproceed.2010.05.144. View

13.

Carey E, Steidley D, Aqel B, Byrne T, Mekeel K, Rakela J . Six-minute walk distance predicts mortality in liver transplant candidates. Liver Transpl. 2010; 16(12):1373-8. DOI: 10.1002/lt.22167. View

14.

Esper S, Waters J . Intra-operative cell salvage: a fresh look at the indications and contraindications. Blood Transfus. 2011; 9(2):139-47. PMC: 3096856. DOI: 10.2450/2011.0081-10. View

15.

Liu L, Niemann C . Intraoperative management of liver transplant patients. Transplant Rev (Orlando). 2011; 25(3):124-9. DOI: 10.1016/j.trre.2010.10.006. View

16.

Pincus K, Tata A, Watson K . Risk of venous thromboembolism in patients with chronic liver disease and the utility of venous thromboembolism prophylaxis. Ann Pharmacother. 2012; 46(6):873-8. DOI: 10.1345/aph.1Q726. View

17.

Adam R, Karam V, Delvart V, OGrady J, Mirza D, Klempnauer J . Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol. 2012; 57(3):675-88. DOI: 10.1016/j.jhep.2012.04.015. View

18.

Nandhakumar A, McCluskey S, Srinivas C, Chandy T . Liver transplantation: Advances and perioperative care. Indian J Anaesth. 2012; 56(4):326-35. PMC: 3469909. DOI: 10.4103/0019-5049.100812. View

19.

Gille J, Seyfarth H, Gerlach S, Malcharek M, Czeslick E, Sablotzki A . Perioperative anesthesiological management of patients with pulmonary hypertension. Anesthesiol Res Pract. 2012; 2012:356982. PMC: 3477529. DOI: 10.1155/2012/356982. View

20.

Houlihan D, Holt A, Elliot C, Ferguson J . Review article: liver transplantation for the pulmonary disorders of portal hypertension. Aliment Pharmacol Ther. 2012; 37(2):183-94. DOI: 10.1111/apt.12140. View