Intraoperative anesthetic management of the liver transplant recipient with portopulmonary hypertension.

PURPOSE OF REVIEW

Liver transplantation in patients with portopulmonary hypertension (POPH) is associated with increased perioperative risk. Important recent advances in the management of liver transplantation recipients with POPH are discussed.

RECENT FINDINGS

The presence of POPH at the time of liver transplantation should not be a contraindication for liver transplantation, as POPH is common and may be related to volume overload and/or high cardiac output (CO). Available data suggest that patients with mild POPH (25-35 mmHg) can safely undergo liver transplantation surgery. In more severe cases, treatment of POPH with a combination of vasoactive drugs may lead to successful liver transplantation with normalization of POPH. The key to successful intraoperative anesthetic management is maintaining the right ventricular preload and avoiding right ventricular dysfunction. Techniques include diuresis, intraoperative hemodialysis, venovenous bypass, or extracorporeal membrane oxygenation. Apart from the surgical and anesthetic techniques used, factors that contribute to increased pulmonary vascular resistance have to be avoided and the continuation of the vasodilators into the intraoperative and postoperative periods is crucial.

SUMMARY

The current article provides a review of the current challenges and advances in the management of liver transplantation recipients with POPH from the anesthetic point of view.