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ICU Management of the Liver Transplant Patient

  • G. Della Rocca
  • M. G. Costa
  • P. Chiarandini
Conference paper

Abstract

The perioperative care of patients undergoing liver transplantation is a crucial clinical situation encountered by surgeons, anesthetists, and critical care physicians. Great strides have been made in the field of liver transplantation since the time when it was considered just an experimental procedure [1]. Liver transplantationrelated mortality and complication rates have significantly decreased and the mean 1-year survival rate is now more than 90% as a result of improved techniques, the consolidation of basic knowledge and experience, better patient selection and preparation, and the use of innovative drugs and technologies [2]. Morbidity after liver transplantation results in suffering, prolonged hospitalization, and increased health care expenditure. Associated conditions, such as acute lung injury (ALI), renal dysfunction, infection, and gastrointestinal tract dysfunction, increase hospital length of stay and costs. Graft-related complications, such as primary non-function, poor (or delayed) early graft function, and early rejection, can result in the loss of the donor organ reducing dramatically the outcome or necessitating retransplantation. Complications after liver transplantation are likely to be multifactorial in origin. Some of the morbidity may be due to a patient’s underlying condition, for example, their preoperative renal function, the United Network for Organ Sharing (UNOS) status, and their model for end-stage liver disease (MELD) score. We will discuss some particular aspects of the early intensive care unit (ICU) management of the liver transplanted patient that reflect the current challenges associated with this procedure including early extubation and non-invasive ventilation; hemodynamic management, splanchnic perfusion, and graft function; fluid management and transfusion; lung and liver function; renal function; and neurological status and sedation.

Keywords

Liver Transplantation Acute Renal Failure Orthotopic Liver Transplantation Liver Transplant Recipient Stroke Volume Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science + Business Media Inc. 2008

Authors and Affiliations

  • G. Della Rocca
    • 1
  • M. G. Costa
    • 1
  • P. Chiarandini
    • 1
  1. 1.Department of Anesthesia and Intensive Care MedicineAzienda Ospedaliero Universitaria S.M. della MisericordiaUdineItaly

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