Neurologic Considerations and Complications Related to Liver Transplantation

THE pathophysiology of liver failure is associated with multisystem derangement including metabolic disequilibrium, low systemic vascular resistance, hyperdynamic circulation, anemia, a rebalanced state of coagulation, and impaired cerebral autoregulation. Liver transplantation is the only definitive treatment for end-stage liver disease and, although outcomes after liver transplant continue to improve, the postoperative phase remains challenging for both patients and clinicians.1 Perioperative organ injury, including injury to the brain, is a leading cause of death in the United States.2 Compared to the transplantation of other solid organs, liver transplant is associated with a higher incidence of neurologic complications, which are reported to be between 9 to 42%3 and frequently accompanied by devastating morbidity and mortality.4 It is critical for the field of perioperative medicine to make advances toward the prevention and treatment of perioperative organ injury, in general, and for brain injury, in particular. Identifying patients at risk for neurologic complications is of vital importance for successful transplantation, may help stratify organ recipients, and has the potential to reduce perioperative risk. Here we present a review of the relevant literature to describe hepatic encephalopathy as a noteworthy consideration for transplant anesthesiologists as well as the incidence, pathophysiology, and prognosis of the major neurologic complications related to liver tra...
Source: Anesthesiology - Category: Anesthesiology Source Type: research