Chapter 41 - Hepatic dysfunction and liver transplantation

Abstract

The pathophysiology of liver disease extends far beyond the liver parenchyma. Cirrhosis is ultimately characterized by multiorgan system dysfunction, resulting in hyperdynamic circulation and low systemic vascular resistance, portopulmonary hypertension, hepatopulmonary syndrome, hepatorenal syndrome, coagulopathy, impaired metabolism, portal hypertension, variceal bleeding, ascites, and encephalopathy. A thorough understanding of the pathophysiology of liver disease and its sequelae is necessary to safely care for these patients in the operating room, as patients with advanced liver disease are high risk for perioperative morbidity and mortality. Liver transplantation requires meticulous management of end-stage liver disease, while simultaneously navigating a complex multistage procedure, including dissection, vascular isolation, and reperfusion.