Liver Transplant Anesthesia

The University of Illinois at Chicago’s transplant program was established in 1968 and has performed more than 2,000 transplant surgeries of the kidney, liver, kidney-pancreas, pancreas, and small bowel. Our transplant program has achieved the highest rates of patient and graft survival in 2009 for kidney, kidney/pancreas, and liver transplant in Illinois despite a very challenging case mix as documented by the latest official release from UNOS. The University of Illinois Medical Center’s one-year adult patient survival rates were 100 percent for kidney-pancreas transplantation, 98 percent for kidney transplantation, and 89 percent for liver transplantation. The one-year graft survival rates were 100 percent for kidney-pancreas transplantation, 96 percent for kidney transplantation, and 85 percent for liver transplantation. These successful results can be attributed to many factors, and the anesthetic and perioperative management has an important role.

During the four week rotation, teaching will be one-on-one by anesthesiologists from the liver team. An orientation regarding the OR set-up and overview of anesthesia for liver transplantation will be done before the rotation. A manual containing the most pertinent articles regarding liver transplantation is distributed by the first day of each rotation. Residents are required to finish reading it–and understand it—by the end of the rotation.

Upon completing this rotation, CA-2 residents should have a basic understanding of a liver transplant patient starting from preoperative evaluation until the postoperative period. The resident should be able to conduct anesthesia for a straight forward liver transplantation, hepatic resection, portal-caval shunt, and bile duct reconstruction.

Residents will place invasive monitoring on patients with end-stage liver disease and will manage massive blood loss using different modes of transfusion, such as the rapid infusion pump and cell saver. The resident will manage coagulation changes with blood products as well as using pharmacological intervention as needed. Residents will be able to use preventive measures for hypothermia in patients undergoing prolonged surgeries and will manage acid/base and electrolyte abnormalities. The resident will safely transport the patient and transfer care to the ICU team.

During the liver rotation, residents will 1) discuss the pros and cons of use of veno-veno bypass, and gain knowledge of alternate techniques when bypass is not used; 2)discuss and describe post-reperfusion injury; 3) discuss the special medical issues related to patients with end stage liver disease and the impact of liver disease on hemostasis; 4) discuss indications for and uses of various inhalation and intravenous anesthetics in transplantation patients.

All the preoperative evaluations and transplant cases done are discussed in detail with the residents. Residents have the option to come to the Liver Transplant meeting and observe the process of listing the patients on the transplant list. The resident will have the opportunity to read and prepare a short topic related to anesthesia for liver transplantation. All residents are encouraged to take another month of the liver transplant anesthesia rotation during the CA-3 year. Residents taking a CA-3 elective in this area will be required to operate with more independence than in the CA-2 year, and will provide care in more difficult or complex anesthesia procedures, and care for more seriously ill patients

Liver anesthesia team faculty:

Katharina Beckmann, MD
Marina Gitman, MD
Hokuto Nishioka, MD
Nikki Wilkinson, MD