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Anesthesia and Perioperative Intensive Care

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Textbook of Liver Transplantation

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Abstract

The perioperative management of the liver transplant recipient presents a formidable challenge. Severe liver disease affects all organ systems, and candidates today are older and have more co-morbidities than ever before. The increasing use of organs from marginal or non-heart-beating donors aggravates these factors in a procedure routinely marked by cardiovascular instability, life-threatening hemorrhage, and major electrolyte, acid–base, and hemostatic disturbances. This chapter outlines key concepts in liver pathophysiology, evaluation of perioperative risk, and multidisciplinary management of the transplant recipient in the perioperative period.

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Abbreviations

ACLF:

Acute-on-Chronic Liver Failure

BMI:

Body Mass Index

CNS:

Central Nervous System

CPET:

Cardiopulmonary Exercise Testing

CPM:

Central Pontine Myelinolysis

CT:

Computed Tomography

EACA:

Epsilon Aminocaproic Acid

ECG:

Electrocardiogram

EF:

Ejection Fraction

ESLD:

End-stage Liver Disease

FEV1:

Forced Expiratory Volume (in 1 s)

FFP:

Fresh Frozen Plasma

FIO2:

Fraction Inspired Oxygen

FRC:

Functional Residual Capacity

HAS:

Human Albumin Solution

HPS:

Hepatopulmonary Syndrome

ICP:

Intracranial Pressure

ICT:

Intracardiac Thrombosis

ICU:

Intensive Care Unit

IHD:

Ischemic Heart Disease

MELD:

Model for End-stage Liver Disease

MRI:

Magnetic Resonance Imaging

NASH:

Non-alcoholic Steatohepatitis

NIPPV:

Non-Invasive Positive Pressure Ventilation

PA:

Pulmonary Artery

PAP:

Pulmonary Artery Pressure

PEEP:

Positive End-expiratory Pressure

PNF:

Primary Non-function

POPH:

Portopulmonary Hypertension

PT:

Prothrombin Time

PTE:

Pulmonary Thromboembolism

PVR:

Pulmonary Vascular Resistance

QTc:

Corrected QT-interval

RAAS:

Renin-Angiotensin-Aldosterone System

ROTEM®:

Rotational Thromboelastometry (device)

RV:

Right Ventricle

SIRS:

Systemic Inflammatory Response Syndrome

SNS:

Sympathetic Nervous System

TEE:

Transesophageal Echocardiography

TEG®:

Thromboelastograph (device)

THAM :

Tris-buffer

UNOS:

United Network for Organ Sharing

VVBP:

Venovenous Bypass

vWF:

Von Willebrand Factor

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Acknowledgments

The author gratefully acknowledges the following colleagues for their important contributions to earlier published work, which have helped shape this manuscript: Andrew Butler FRCS, Andre De Wolf MD, James Findlay MD, and Andrea De Gasperi MD.

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Authors and Affiliations

  1. Division of Perioperative Care, Addenbrooke’s Hospital, Cambridge, UK

    John R. Klinck

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Editors and Affiliations

  1. Department of Surgery, Oncology, and Gastroenterology Mutltivisceral Transplant Unit, University of Padua, Padua, Italy

    Patrizia Burra

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Klinck, J.R. (2022). Anesthesia and Perioperative Intensive Care. In: Burra, P. (eds) Textbook of Liver Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-030-82930-8_15

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