Anesthesia for Liver Transplantation

Abstract

Advances in surgical and anesthetic techniques have provided great success in liver transplantation, with more than 4,000 liver transplantations performed annu ally in the United States. Indications for transplanta tions include the various forms of cirrhosis, commonly resulting from hepatitis B or C, alcoholism, or acute hepatic failure from drug toxicity or poisoning. Cadav eric donor livers are resected and may be transplanted up to 24 hours later while the recipient is prepared for surgery. These operations may last 10 hours and require large amounts of blood products. Extrahepatic prob lems from their end-stage liver disease are common and affect nearly all organ systems. Intraoperative monitor ing of acid-base status, electrolytes, intravascular vol ume, and coagulation parameters is essential. Preexist ing coagulopathies from liver disease, complications of massive transfusions and fibrinolysis from the new liver create complex coagulation disturbances requiring prompt diagnosis and treatment. Metabolic (lactic) aci dosis is common and severe. Reperfusion of the donor liver can result in a dramatic and rapid fall in blood pressure as well as hyperkalemia.