2018 Clinical Update in Liver Transplantation

Nicholas W Markin, Kyle J. Ringenberg, Cale A. Kassel, Charles R. Walcutt, M. Megan Chacon

Research output: Contribution to journalReview article

Abstract

Liver transplantation (LT) continues to be the gold standard for treating end-stage liver disease, and challenges that are posed to the anesthesiologist during transplantation are well known. Successful liver transplantation requires knowledge, recognition, and treatment of hemodynamic and metabolic disturbances by the anesthesiologist. End-stage liver disease causes unique derangements to the clotting cascade, increasing risk both for hemorrhagic and thrombotic events. Cirrhotic cardiomyopathy may be masked for years because of low systemic vascular resistance in cirrhosis, and overt heart failure can be precipitated by LT. Surveys of high-volume transplant centers show an overall transesophageal echocardiography (TEE) use rate of 95%. Guidelines on the use of TEE in LT have mirrored safety findings in several studies and suggest TEE may be used for patients with esophageal varices if the benefit outweighs the risk. This review will cover organ system dysfunction in liver cirrhosis and the implications for liver cirrhosis patients and review recent advances in pathophysiology and treatments. In addition, the authors will highlight the concept of enhanced recovery after surgery and how it pertains to the LT patient population. Lastly, the authors review recent advances in organ preservation and optimization.

Original languageEnglish (US)
JournalJournal of Cardiothoracic and Vascular Anesthesia
DOIs
StatePublished - Jan 1 2019

Fingerprint

Liver Transplantation
Transesophageal Echocardiography
End Stage Liver Disease
Liver Cirrhosis
Organ Preservation
Esophageal and Gastric Varices
Cardiomyopathies
Vascular Resistance
Fibrosis
Heart Failure
Transplantation
Hemodynamics
Guidelines
Transplants
Safety
Therapeutics
Population
Anesthesiologists

Keywords

  • cirrhotic cardiomyopathy
  • coagulation
  • enhanced recovery
  • liver transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

2018 Clinical Update in Liver Transplantation. / Markin, Nicholas W; Ringenberg, Kyle J.; Kassel, Cale A.; Walcutt, Charles R.; Chacon, M. Megan.

In: Journal of Cardiothoracic and Vascular Anesthesia, 01.01.2019.

Research output: Contribution to journalReview article

Markin, Nicholas W ; Ringenberg, Kyle J. ; Kassel, Cale A. ; Walcutt, Charles R. ; Chacon, M. Megan. / 2018 Clinical Update in Liver Transplantation. In: Journal of Cardiothoracic and Vascular Anesthesia. 2019.
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