Intensive care management in adult liver transplantation


Akan M.

ANAESTHESIA PAIN & INTENSIVE CARE, vol.20, no.1, pp.92-110, 2016 (ESCI) identifier identifier

  • Publication Type: Article / Review
  • Volume: 20 Issue: 1
  • Publication Date: 2016
  • Journal Name: ANAESTHESIA PAIN & INTENSIVE CARE
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus
  • Page Numbers: pp.92-110
  • Keywords: Liver transplantation, Postoperative period, Intensive care, Liver failure, CENTRAL VENOUS-PRESSURE, ACUTE LUNG INJURY, RENAL REPLACEMENT THERAPY, END-EXPIRATORY PRESSURE, RISK-FACTORS, BLOOD-LOSS, GASTROINTESTINAL COMPLICATIONS, INTRAOPERATIVE HYPERGLYCEMIA, NEUROLOGICAL COMPLICATIONS, RESPIRATORY COMPLICATIONS
  • Dokuz Eylül University Affiliated: Yes

Abstract

Postoperative intensive care management of transplanted cases has shown a rapid development since the introduction of liver transplantation ( LT). While one-year survival rate after LT was 79% in 1998, it raised to 90% in 2008, and while ten-year survival rate was 33% in 1998, it raised to 66% in 2010 owing to improvements in preoperative optimization, surgical technique, intraoperative anesthesia management, organ preservation, intensive care and immunosuppressive treatment. Rapid hemodynamic stabilization, correction of severe coagulopathy, respiratory stabilization and early weaning from mechanical ventilation, appropriate fluid-electrolyte therapy, preservation of renal function, prevention of graft rejection and prophylaxis/treatment of infection are particularly important in intensive care management of liver transplanted patients. Since early postoperative period is critical, close monitoring, stabilization and maintenance of cardiorespiratory functions, frequent examination of graft function, early identification of complications and prompt treatment of extrahepatic organ failure are mandatory in order to reduce mortality/morbidity.