Ul Haq Muhammad Irfan, Hameed Malika, Duncan Bruce
Department of Anaesthesiology, Aga Khan University Hospital, Karachi, Pakistan.
Department of Anaesthesiology, St James's University Hospital, Leeds, United Kingdom.
Turk J Anaesthesiol Reanim. 2022 Feb;50(1):8-12. doi: 10.5152/TJAR.2021.1459.
More than 50 years have passed since Starzl et al. did the first liver transplant. Since then the transplant speciality has witnessed enormous growth and at present more than 1 000 000 liver transplants have been performed to date in over 100 liver transplant centers around the world. In Europe and North America, the predominant mode is deceased donor liver transplantation, while in Turkey and most of the Asian countries, the living donor liver transplant or split liver transplantation is the most widely available method for liver transplantation. The etiology of end-stage liver disease is also different in developed and developing countries. Liver recipients usually have multiple comorbidities and in addition, derangements in liver functions also indirectly affect other systems. The anaesthesiologist plays a very crucial role as a perioperative physician concerning liver transplantation. He is the lead person involved, from preoperative workup to intraoperative management and postoperative care in critical care units. Anaesthesiologists are also actively involved in developing organ transplant pathways and protocols for perioperative assessments. Although there are local protocols and pathways for assessing liver transplant recipients, there is a lack of standardization in the literature for such assessments. This article highlights essential aspects in assessing liver transplant recipients and the role of some specific assessment tools and establishes a standardized protocol for selecting and optimizing suitable patients, thereby reducing the mortality and morbidity associated with this major surgery.
自斯塔兹尔等人首次进行肝移植以来，已经过去了50多年。从那时起，移植专业见证了巨大的发展，目前全球100多个肝移植中心已进行了超过100万例肝移植手术。在欧洲和北美，主要的模式是尸体供肝肝移植，而在土耳其和大多数亚洲国家，活体供肝肝移植或劈离式肝移植是最广泛应用的肝移植方法。发达国家和发展中国家终末期肝病的病因也有所不同。肝移植受者通常有多种合并症，此外，肝功能紊乱也会间接影响其他系统。麻醉医生作为肝移植围手术期的医生起着非常关键的作用。他是从术前检查到术中管理以及重症监护病房术后护理的主要负责人。麻醉医生还积极参与制定器官移植路径和围手术期评估方案。尽管有评估肝移植受者的当地方案和路径，但文献中此类评估缺乏标准化。本文重点介绍了评估肝移植受者的基本方面以及一些特定评估工具的作用，并建立了一个选择和优化合适患者的标准化方案，从而降低与这种大手术相关的死亡率和发病率。
