Anesthesia During Liver Transplant: Hepatic Function, TEG, Massive Transfusion, Stages of Liver Transplantation, and MELD Scoring

  • Kevin D. Marcus
  • Jonathan L. Benumof


This chapter examines a case of liver transplantation in a patient with chronic hepatitis B infection and hepatocellular carcinoma in which there was primary graft nonfunction of the donor organ after implantation into the recipient. The general functions of the healthy liver are discussed in addition to how these functions break down in the presence of pathology. Diagnosis of liver failure and use of the MELD scoring system for liver transplantation are reviewed.

This case also highlights both the expected and a more rare, or unexpected, complication associated with liver transplantation. The lessons learned from this case will focus on the stages of liver transplantation as well as an assessment of acquired coagulopathy via thromboelastograph (TEG), massive transfusion protocols, and the expected complications of massive transfusion of blood products. The goal of this review is to provide the anesthesiologist with a framework for dealing with complications of hepatic failure, whether or not liver transplantation is involved.


Liver transplant Hepatic physiology Hepatic pathophysiology Coagulopathy Portal hypertension MELD score Hepatocellular carcinoma MELD exception score Thromboelastogram (TEG) Pre-anhepatic Anhepatic Neohepatic Post-reperfusion syndrome Primary graft nonfunction Massive transfusion Hemorrhage Dilutional coagulopathy Citrate intoxication CPDA blood product storage Oxyhemoglobin dissociation curve 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kevin D. Marcus
    • 1
  • Jonathan L. Benumof
    • 2
  1. 1.Department of AnesthesiologyMission Hospital – Mission ViejoMission ViejoUSA
  2. 2.Department of AnesthesiologyUniversity of California, UCSD Medical Center, UCSD School of MedicineSan DiegoUSA

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