Perioperative Intensive Care for Liver Transplantation

Hwang, Shin; Choi, Dong Lak; Ahn, Cheol Soo; Park, Dong Eun; Joo, Sun Hyung; Jeon, Jang Yong; Kim, Kyeong Mo; Nah, Yang Won; Park, Kwang Min; Lee, Young Joo; Lee, Sung Gyu

Abstract

Many liver recipients have required intensive care, which is individualized and customized to each recipient. Prerequisites qualifying this care are wide comprehension of characteristics of end-stage liver disease and mechanisms of surgical procedures and immunologic knowledge. We present our principles of intensive care and experience from more than 300 cases of liver transplantation. There are roughly two types of liver transplantation, cadaveric and living-donor. These two types are different in their postoperative courses as following; severity of preservation injury, graft-size matching and morphologic liver regeneration and risk of vascular and biliary complications. Intensive care for liver recipients should be directed toward preventive and protective care along reasonable prediction of its clinical course. We described our experience about following subjects: management of hepatorenal syndrome, fulminant hepatic failure, acute renal failure, pneumonia, disturbance of consciousness, prophylaxis of viral hepatitis B, tumor recurrence, use of antibiotics, induction of liver function recovery, maintenance of vital signs, electrolyte balance, diet and infection control, nutritional support. The most important factor is the state of transplanted liver graft in determination of posttransplant course. If the graft functions well, many problems will be solved spontaneously. If not, intensive care will be required. Most of operative complications are related to the surgery itself, so that comprehension to surgical procedures to each recipient should be preceded for early detection and proper management. To achieve a favorable posttransplant course, all factors including maintenance of vital signs, elimination of obstacles to hepatic recovery, appropriate immunosuppression and solution of surgical complications should be met altogether. Of course, every member of liver transplantation team should pay durable attention and dedication to each liver recipient.