Editorial
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World J Hepatol. Mar 27, 2011; 3(3): 61-71
Published online Mar 27, 2011. doi: 10.4254/wjh.v3.i3.61
Intensive care management of liver transplanted patients
Paolo Feltracco, Stefania Barbieri, Helmut Galligioni, Elisa Michieletto, Cristiana Carollo, Carlo Ori
Paolo Feltracco, Stefania Barbieri, Helmut Galligioni, Elisa Michieletto, Cristiana Carollo, Carlo Ori, Department of Pharmacology and Anesthesiology, University Hospital of Padova, Padova 35100, Italy
Author contributions: All named authors have made substantial contributions in writing and revising this article.
Correspondence to: Paolo Feltracco, MD, Department of Pharmacology and Anesthesiology, University Hospital of Padova, Via Cesare Battisti, Padova 35100, Italy. paolofeltracco@inwind.it
Telephone: +39-49-8218285
Received: October 15, 2010
Revised: December 10, 2010
Accepted: December 17, 2010
Published online: March 27, 2011
Abstract

Advances in pre-transplant treatment of cirrhosis-related organ dysfunction, intraoperative patient management, and improvements in the treatment of rejection and infections have made human liver transplantation an effective and valuable option for patients with end stage liver disease. However, many important factors, related both to an increasing “marginality” of the implanted graft and unexpected perioperative complications still make immediate post-operative care challenging and the early outcome unpredictable. 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. 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. Strict monitoring and sustainment of cardiorespiratory function, frequent assessment of graft performance, timely recognition of unexpected complications and the institution of prophylactic measures to prevent extrahepatic organ system dysfunction are mandatory in the immediate post-operative period. A reduced rate of complications and satisfactory outcomes have been obtained from multidisciplinary, collaborative efforts, skillful vigilance, and a thorough knowledge of pathophysiologic characteristics of the transplanted liver.

Keywords: Post-liver transplant critical care; Liver transplantation; Post-operative complications; Liver graft dysfunction