Home > Journals > Minerva Gastroenterologica e Dietologica > Past Issues > Minerva Gastroenterologica e Dietologica 2010 September;56(3) > Minerva Gastroenterologica e Dietologica 2010 September;56(3):305-30

CURRENT ISSUE
 

ARTICLE TOOLS

Reprints

MINERVA GASTROENTEROLOGICA E DIETOLOGICA

A Journal on Gastroenterology, Nutrition and Dietetics


Indexed/Abstracted in: CAB, EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index


eTOC

 

REVIEWS  PERIOPERATIVE CARE IN LIVER TRANSPLANTATION


Minerva Gastroenterologica e Dietologica 2010 September;56(3):305-30

language: English

Critical care issues following orthotopic liver transplantation

Keegan M. T., Pickering B. W.

Division of Critical Care, Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA


PDF  


Orthotopic liver transplantation (OLT) remains a formidable undertaking. A multidisciplinary approach to pre-operative optimization and intra- and postoperative care of patients undergoing OLT increases the chance of a successful outcome. Although there have been moves towards avoidance of Intensive Care Unit (ICU) admission for “routine” OLT recipients, critical care practitioners continue to play a key role in liver transplant programs in the MELD era. Use of protocolized care delivery and innovative ICU therapeutic interventions have streamlined the pre-operative optimization and perioperative care of OLT recipients. The postoperative course is significantly influenced by the patient’s pre-operative status, the intraoperative course and the function of the liver graft. In addition to discussion of general ICU concepts such as the use of prognostic scoring systems and protocolization of care, this review will use an organ-system based approach to describe the postoperative ICU care of OLT recipients. We discuss hemodynamic management, ventilator weaning, optimization of sedation and analgesia, and the investigation and management of renal and metabolic abnormalities. In addition, we examine postoperative complications including hemor-rhage, central nervous system pathology and graft dysfunction. The review concludes with a discussion of the additional challenges practitioners face when dealing with living donor liver transplantation and donation after cardiac death.

top of page

Publication History

Cite this article as

Corresponding author e-mail

keegan.mark@mayo.edu