Chapter 24 - Peri-operative care and early complications

Summary

This chapter outlines the pathophysiology of liver disease as it affects patient selection and management in the peri-operative period and key aspects of anesthetic, surgical, and early postoperative care. The most important early complications are primary non-function, hepatic artery thrombosis, and bleeding. Pulmonary hypertension is seen in up to 20% of adult liver transplant candidates and is usually identified by transthoracic echocardiography. Full multi-system assessment should be performed before listing for transplantation, and the patient reviewed when a donor liver becomes available. Management of liver transplant recipients between transplantation and discharge is usually undertaken by a multi-disciplinary team that includes intensivists, hepatologists, and transplant surgeons. Most liver recipients are transferred to the intensive care unit (ICU) for postoperative care. Sepsis is common after transplant and is frequently associated with liver dysfunction. Culture results from the donor and targeted antimicrobial treatment should be considered in recipients with unusual presentations of sepsis.