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Assessment of Early Graft Function and Management of Early Graft Failure

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Peri-operative Anesthetic Management in Liver Transplantation

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Abstract

Liver transplantation (LT) has now been universally accepted as the standard of care for patients with decompensated end-stage liver disease, acute liver failure (ALF), and a few other metabolic disorders. Resumption of graft function during and immediately after surgery is very crucial in determining patient outcomes. Graft survival approximates patient survival in most circumstances. Although the rates of cadaveric donation have increased, there seems to be a disproportionate increase in the number of recipients on waitlist. Living donor liver transplantation (LDLT) was developed with the main purpose of reducing waitlist mortality which, unfortunately, has not been able to provide a complete solution for the problem. To overcome this, the transplant community has increased the margins for acceptance of a donor in deceased donor liver transplantation (DDLT) and a smaller volume graft in LDLT to prioritize donor safety [1, 2]. This has led to increasing use of marginal grafts which increase the likelihood of primary graft dysfunction (PGD). It has been well demonstrated that recipients who develop PGD have a higher risk of morbidity and mortality, but the benefits might outweigh the risks of dying in the waitlist without a suitable organ.

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Abbreviations

ALF:

acute liver failure

ALT:

Alanine aminotransferases

AST:

Aspartate aminotransferases

CIT:

cold ischemia time

CRRT:

continuous renal replacement therapy

DCD:

donation after cardiac death

DDLT:

Deceased donor liver transplantation

EAD:

early allograft dysfunction

ECLS:

extracorporeal liver support systems

HVP:

high volume plasmapheresis

ICG-PDR:

Indocyanine green-plasma disappearance rate

IPGF:

initial poor graft function

IRI:

ischemia reperfusion injury

LDLT:

Living donor liver transplantation

LiMax:

Liver maximal function capacity

LT:

Liver transplantation

MARS:

Molecular adsorbent recirculating system

MEAF:

Model for early allograft function

NAC:

N-acetyl cysteine

PEEP:

positive end expiratory pressure

PGD:

primary graft dysfunction

PLP:

Plasmapheresis

PNF:

primary non function

PRS:

reperfusion syndrome

RRT:

renal replacement therapy

SIRS:

systemic inflammatory response

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Authors and Affiliations

  1. Department of Liver Intensive Care and Anaesthesia, Dr. Rela Institute and Medical Centre, Chennai, India

    Akila Rajakumar, Premchandar Velusamy & Ilankumaran Kaliamoorthy

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  1. Akila Rajakumar
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  2. Premchandar Velusamy
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  3. Ilankumaran Kaliamoorthy
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Editors and Affiliations

  1. Liver Transplant, GI Anesthesia & Intensive Care, Medanta The Medicity, Gurgaon, India

    Vijay Vohra

  2. Liver Transplant, GI Anesthesia & Critical Care, Medanta The Medicity, Gurgaon, Haryana, India

    Nikunj Gupta

  3. Liver Transplant & General Anaesthesia, Narayana Superspeciality Hospital, Gurgaon, India

    Annu Sarin Jolly

  4. Liver Transplant, GI Anesthesia & Critical Care, Formerly at Medanta The Medicity, Gurgaon, India

    Seema Bhalotra

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Rajakumar, A., Velusamy, P., Kaliamoorthy, I. (2023). Assessment of Early Graft Function and Management of Early Graft Failure. In: Vohra, V., Gupta, N., Jolly, A.S., Bhalotra, S. (eds) Peri-operative Anesthetic Management in Liver Transplantation. Springer, Singapore. https://doi.org/10.1007/978-981-19-6045-1_39

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