2020 Clinical Update in Liver Transplantation

Abstract

The gold standard treatment of end-stage liver disease continues to be liver transplantation (LT). The challenges of LT require skilled anesthesiologists to anticipate physiologic changes associated with end-stage liver disease (ESLD) as well as surgical considerations that affect multiple organ systems. While on the waiting list, patients may be placed new anticoagulation medications that can confound already complex coagulopathy in LT patients. Pain management is often an afterthought for such a complex procedure but appropriate medications can help control pain while limiting opioid medications. Surgical stress and medications for immunosuppression can affect perioperative glucose management in ways that have implications for patient and graft survival. 2020 provided a new challenge for anesthesiologist, the COVID-19 pandemic. The uncertainty of the novel respiratory virus challenged providers in beyond just LT patients.

Systematic review and meta-analysis of the co-occurrence of atrial fibrillation and liver transplantation: a lethal combination

“…For example, traditional postoperative hemodynamic challenges may result in NOAF due either to hemodynamic instability or inotropic hemodynamic support [25]. NOAF after LT could be associated with autonomic dysfunction, surgical stress, increased catechola- BMI -body mass index; MELD -model for end-stage liver disease; NS -not specified; PO-AF -postoperative atrial fibrillation www.journals.viamedica.pl mine levels, pre-existing pericardial inflammation, and cardiac malfunction [26]. Acidosis, hypo/hyperkalemia, hypocalcemia, hypoglycemia, hypothermia, a higher MELD score, and fulminant hepatic failure after LT may also result in NOAF [14].…”

Whole Liver Derived Acellular Extracellular Matrix for Bioengineering of Liver Constructs: An Updated Review

“…Globally, the demand for organs far outstrips the supply. The harsh reality of this disparity in organ need vs adequate availability is that millions of potential patients die on the waiting list [7][8][9]. According to the Organ Procurement and Transplantation Network, in the United States alone, one in four patients seeking a liver transplant either die while waiting (12%), or become too unwell to undergo a liver transplantation operation (13%) [10][11][12][13].…”

Increased Platelet Aggregation in Adults After Orthotopic Liver Transplantation Indicates Higher Probability of Early Postoperative Survival

“…Adult orthotopic liver transplantation (OLT) is an important method for treating various severe acute or advanced chronic liver diseases [ 1 ]. Following the development of surgical techniques, anaesthesiological approaches and surgical technique, along with improvements in immunosuppressive regimens, the mortality after liver transplantation (LT) associated with surgical factors has decreased and one-year survival rates were nearly 80–90% for transplant recipients [ 2 ].…”