Hemodynamic Monitoring During Liver Transplantation
Orthotopic liver transplantation (OLTx) is a surgical procedure that is currently performed to treat end-stage liver disease (ESLD) in selected patients. It was first performed by Starzl and colleagues in 1963 in a 3-year-old boy with biliary atresia, who died during surgery because of massive bleeding. The following 5 patients survived no longer than 23 days, and hence the transplantation program was stopped.1 In the following years, because of improvement in the surgical technique, organ support, and immunosuppressive therapy (discovery and introduction of cyclosporine), liver transplantation procedures restarted and were performed all over the world. In 2015 >6500 livers were transplanted in the United States (adult, pediatric, and living-related), with a survival of >70% after 5 years in adults.2 Despite the improvements reached over >50 years, liver transplantation is still a challenging procedure for both the surgeon and the anesthesiologist because of the hemodynamic, metabolic, and coagulative derangements that can occur during all phases of the procedure (hepatectomy, anhepatic, and reperfusion).