The evolution of liver transplantation practices

Abstract

Over the last 40 years, liver transplantation developed from a compassionate attempt to save the lives of patients with end stage liver disease into a sophisticated therapy, for which 1-year survival rates now approach 90%. To understand the evolution of anesthetic perioperative care, its origin needs to be considered. The implications of this evolution on patient outcomes are important and have not been comprehensively reviewed. This article attempts to fill this gap. Policies for allocating organs continue to evolve in order to better serve those in greatest need as more reliable predictors of pretransplant mortality emerge. Novel approaches to increase the number of organs available for transplantation include donation after cardiac death, living donation and extending the criteria for organ acceptance. Progress in intraoperative hemostatic management and blood loss control, understanding renal physiology, and early extubation protocols are improving outcomes, and contribute to the slowly expanding evidence base for anesthetic perioperative care in liver transplantation. The evidence for perioperative best practices in liver transplantation is at a nascent stage. Increased multicenter and international collaborative research in perioperative anesthetic care of liver transplant patients is needed to extend this body of knowledge required to improve transplant outcomes.