Patient with a liver transplant

Learning objectives

Liver transplantation is a treatment option for end-stage liver disease (ESLD) and acute liver failure
Orthotopic liver transplantation is the most common technique and involves the substitution of a diseased native liver with a normal liver (or part of one) taken from a deceased or liver donor in the same anatomic position as the original liver
Recipients may present for nontransplant surgery later in life

The majority of recipients are 30-60 years old and in good health
Cardiopulmonary effects of ESLD reverse shortly after transplantation
Most patients have normal liver function unless there is rejection, sepsis, or recurrence of the original disease
High incidence of hypertension after liver transplantation
Immunosuppression increases susceptibility to infection and other common side effects
- Corticosteroids: Hypertension, hypokalemia, hyperglycemia, adrenal suppression
- Tacrolimus: Hypertension, renal dysfunction, electrolyte abnormalities, hyperglycemia
- Cyclosporine: Nephrotoxicity and hyperkalemia, hepatotoxicity, neurotoxicity, hypertension
- Azathioprine: Bone marrow suppression

Increasing numbers of patients have a successful liver transplant and may require nontransplant surgery later in life
Careful preoperative assessment is essential, especially for liver and kidney function
The goal of perioperative management is to avoid any factors that might compromise hepatic and renal function and to minimize the infection risk with antibiotic prophylaxis and careful aseptic techniques