title: Perioperative monitoring in liver transplant patients.
abstract: Liver transplant (LT) is a major surgical undertaking involving major fluid shifts, hemodynamic instability and metabolic derangements in a patient with preexisting liver failure and multisystemic derangements. Monitoring and organ support initiated in the preoperative phase is continued intraoperatively and into the postoperative phase to ensure an optimal outcome. As cardiovascular events are the leading cause of non-graft related death among LT recipients, major emphasis is placed on cardiovascular monitoring. The other essential monitoring are the continuous assessment of coagulapathy, extent of metabolic derangements, dyselectrolytemis and intracranial pressure monitoring in patients with fulminant hepatic failure. The type and extent of monitoring differs with need according to preexisting child status of the patient and the extent of systemic derangements. It also varies among transplant centers and is mainly determined by individual or institutional practices.
authors.affiliation: Dept. of Anesthesiology and Critical Care, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi 110070, India.
authors.forename: Shweta
authors.initials: S
authors.lastname: Singh
authors.affiliation: Dept. of Anesthesiology and Critical Care, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi 110070, India.
authors.forename: Vaibhav
authors.initials: V
authors.lastname: Nasa
authors.affiliation: Dept. of Anesthesiology and Critical Care, Institute of Liver and Biliary Sciences, D1 Vasant Kunj, New Delhi 110070, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Tandon
keywords: ACT, activated clotting time; ALF; ALF, acute liver failure; APTT, activated partial thromboplastin time; ARDS, acute respiratory distress syndrome; CCO, continuous CO; CCTs, conventional coagulation tests; CI, cardiac index; CL, clot lysis; CO, cardiac output; CR, clot rate; CVP, central venous pressure; ESLD, end stage liver disease; EVLWI, extra vascular lung water index; ICG, indocyanine green; ICH, intracranial hypertension; ICP, intracranial pressure; LT, liver transplant; MA, maximum amplitude; ONSD, optic nerve sheath diameter; PAC, pulmonary artery catheter; PAOP, pulmonary arterial occlusion pressure; PF, platelet function; PI, pulsatility index; PT, prothrombin time; ROTEM, rotation thrombelastometry; RVEDV, right ventricular end-diastolic volume; SV, stroke volume; SVR, systemic vascular resistance; TCD, transcranial Doppler; TDCO, thermodilution principle; TEE, transesophageal echocardiography; TEG, thrombelastography; cirrhosis; coagulopathy; intracranial pressure monitoring; liver transplant; mPAP, mean pulmonary artery pressure