Education  |   May 2018
Neurologic Considerations and Complications Related to Liver Transplantation
Author Notes
  • From the Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan.
  • This article is featured in “This Month in Anesthesiology,” page 1A.
    This article is featured in “This Month in Anesthesiology,” page 1A.×
  • Figure 1 was enhanced by Sara Jarret, C.M.I.
    Figure 1 was enhanced by Sara Jarret, C.M.I.×
  • Submitted for publication October 12, 2017. Accepted for publication January 29, 2018.
    Submitted for publication October 12, 2017. Accepted for publication January 29, 2018.×
  • Address correspondence to Dr. Mashour: Department of Anesthesiology, University of Michigan, 1H247 University Hospital, 1500 East Medical Center Drive, SPC 5048, Ann Arbor, Michigan 48109. gmashour@med.umich.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Central and Peripheral Nervous Systems / Gastrointestinal and Hepatic Systems / Clinical Focus Review
Education   |   May 2018
Neurologic Considerations and Complications Related to Liver Transplantation
Anesthesiology 5 2018, Vol.128, 1008-1014. doi:10.1097/ALN.0000000000002148
Anesthesiology 5 2018, Vol.128, 1008-1014. doi:10.1097/ALN.0000000000002148
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 transplant surgery. We will describe both monitoring and preventive strategies for selected conditions across various phases of care.
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