Liver transplantation

Overview

Liver transplantation has become widely accepted and effective therapy for different irreversible acute and chronic liver diseases. Transplantationcan extend the life expectancy period, and quality of life. First clinical liver transplantation was performed at Colorado University in 1963; however,this method of treatment remained in clinical experimental stage until the end of 70’s. The introduction of new immunosuppresive agents into clinicalpractice in 80’s (cyclosporine A and antilymphocyte agents) increased one-year survival rate from 40% to 60% and triggered a new progressivere-development of clinical transplantology. Along with increasing number of transplant procedures, indications have become clearer, and anesthetic,surgical and nursing techniques and skills improved. All those factors contributed to improved survival of transplant patients, with one-year survivalrate becoming as high as 90%, and 3-year survival rate 80%. In Brno, this program was launched in 1983, after a 9-year period of pre-clinicalexperimental program on laboratory animals. Until 1998, 87 transplant procedures were performed in 85 patients. This paper reviews the preoperativeassessment of a patient, preparation for the procedure, anesthesiologic and surgical techniques, veno-venous bypass and perioperative care for thepatient as were developed from the early stages in 1983. In the group of 76 patients (1994-1998) we describe cardiovascular, hematologic andbiochemical changes associated with liver transplantation.

Key words:
anesthesia - perioperative care - surgical technique - veno-venous bypass