Critical care issues following orthotopic liver transplantation

M. T. Keegan, Brian W Pickering

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Orthotopic liver transplantation (OLT) remains a formidable undertaking. A multidisciplinary approach to preoperative optimization and intraand postoperative care of patients undergoing OLT increases the chance of a successful outcome. Although there have been moves towards avoidance of Intensive Care Unit (ICU) admission for "routine" OLT recipients, critical care practitioners continue to play a key role in liver transplant programs in the MELD era. Use of protocolized care delivery and innovative ICU therapeutic interventions have streamlined the pre-operative optimization and perioperative care of OLT recipients. The postoperative course is significantly influenced by the patient's preoperative status, the intraoperative course and the function of the liver graft. In addition to discussion of general ICU concepts such as the use of prognostic scoring systems and protocolization of care, this review will use an organ-system based approach to describe the postoperative ICU care of OLT recipients. We discuss hemodynamic management, ventilator weaning, optimization of sedation and analgesia, and the investigation and management of renal and metabolic abnormalities. In addition, we examine postoperative complications including hemorrhage, central nervous system pathology and graft dysfunction. The review concludes with a discussion of the additional challenges practitioners face when dealing with living donor liver transplantation and donation after cardiac death.

Original languageEnglish (US)
Pages (from-to)305-330
Number of pages26
JournalMinerva Gastroenterologica e Dietologica
Volume56
Issue number3
StatePublished - Sep 2010

Fingerprint

Critical Care
Liver Transplantation
Intensive Care Units
Postoperative Care
Transplants
Ventilator Weaning
Perioperative Care
Living Donors
Liver
Analgesia
Central Nervous System
Hemodynamics
Pathology
Hemorrhage
Kidney

Keywords

  • Critical care
  • Intensive care
  • Intraoperative period
  • Liver transplantation
  • Postoperative period

ASJC Scopus subject areas

  • Gastroenterology
  • Internal Medicine
  • Nutrition and Dietetics
  • Endocrinology, Diabetes and Metabolism

Cite this

Critical care issues following orthotopic liver transplantation. / Keegan, M. T.; Pickering, Brian W.

In: Minerva Gastroenterologica e Dietologica, Vol. 56, No. 3, 09.2010, p. 305-330.

Research output: Contribution to journalArticle

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