Liver Diseases pp 757-767 | Cite as

Anaesthesia for Liver Transplantation

  • Donald M. Milliken
  • Brian R. Davidson
  • Michael D. Spiro


Perioperative risk for patients undergoing liver transplantation is influenced by the severity of their liver disease as well as by extrahepatic complications including frailty, sarcopenia, poor exercise tolerance and cardiorespiratory pathology. Safe intraoperative care depends upon an understanding of the surgical procedure and an appreciation of the physiological changes which occur during the anhepatic stage and at reperfusion of the donor graft. Cardiovascular and respiratory dysfunction, acute kidney injury, and severe bleeding due to the surgery, portal hypertension and coagulopathy are common in the perioperative period. Robust strategies for detecting and correcting coagulopathy, as well as meticulous attention to fluid balance and electrolytes, are essential. Live donors are extensively screened and in good general health. Their intraoperative management is similar to that of patients undergoing liver resection.


Anaesthesia Anhepatic Reperfusion Coagulopathy Viscoelastic Haemorrhage Frailty Sarcopenia Portopulmonary hypertension Hepatopulmonary syndrome Cirrhotic cardiomyopathy Live donor 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Donald M. Milliken
    • 1
    • 2
  • Brian R. Davidson
    • 3
  • Michael D. Spiro
    • 1
    • 2
    • 4
  1. 1.Royal Free Perioperative ResearchLondonUK
  2. 2.Liver Transplant and HPB AnaesthesiaThe Royal Free London NHS Foundation TrustLondonUK
  3. 3.Department of Hepato-pancreatico-biliary SurgeryRoyal Free HospitalLondonUK
  4. 4.The Royal Free London NHS Foundation TrustUniversity College LondonLondonUK

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