POSTOPERATIVE CARE OF LIVING DONOR LIVER TRANSPLANTATION RECIPIENT

Abstract

Liver transplantation (LDLT) has become a widely accepted treatment for a variety of liver diseases, such as viral and alcoholic cirrhosis, liver malignancy, acute liver failure, and many metabolic abnormalities. As a result of improvement in anesthesiological and surgical skill, organ support device adoption, advanced understanding of transplant immunology, and better critical care management of complications, liver transplanted patients survive longer. In recent years sicker patients with multiple comorbidities and organ dysfunction have been undergoing Liver transplantation; appropriate critical care management is required to support prompt graft recovery and prevent systemic complications. The early post-operative period is a crucial time when strict monitoring and sustainment of cardiorespiratory function, frequent assessment of allograft performance, timely recognition of unexpected complications and prompt treatment of extrahepatic organ system dysfunction are mandatory. Intensive care management of liver transplanted patients mainly centers on rapid hemodynamic stabilization, correction of coagulopathy, early weaning from mechanical ventilation, proper fluid administration, kidney function preservation, graft rejection prevention, and infection prophylaxis. Early post-operative management is highly demanding as significant changes may occur in both the allograft and the “distant” organs. A functioning transplanted liver is almost always associated with organ system recovery, resulting in a new life for the patient. However, in the unfortunate event of graft dysfunction, the unavoidable development of multi-organ failure will require an enhanced level of critical care support and a prolonged ICU stay. Complications can be broadly divided into surgical and non-surgical complications. Surgical complications are mostly operation- related and can be further subdivided into post-operative hemorrhage, portal vein obstruction, hepatic vein thrombosis and biliary complications. Non-surgical complications include pulmonary, renal, cardiovascular, coagulopathy, neurological and infection in the form of wound infection, pneumonia, opportunistic infections & recurrence of hepatitis B virus.