الفهرس 
Pathophysiology of cardiovascular, renal and hepatic systems in liver transplantationOnly 14 pages are availabe for public view
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Abstract
Liver transplantation has become the treatment of choice for end-stage liver failure and some cases of acute liver failure. The first successful orthotopic liver transplant was performed by Starzl in 1963. Since then, advances in surgical and anaesthetic management have resulted in prolonged graft survival and overall 1 yr survival rates >80%.
In the last decades, the survival of liver transplanted patients and grafts have had a great improvement due to many factors. Careful preoperative evaluation in transplant recipients, experience and different approach have major role in the selection of candidates and in the diagnosis and treatment of preoperative complications.
Coagulation is often impaired when blood loss occurs during liver transplantation. Haemodilution caused by fluid replacement impairs coagulation by reducing the concentration of clotting factors. The type of fluid used may also affect coagulation.
Hypovolemia is frequently encountered during liver transplantation. Fluid management remains a controversial subject in perioperative medicine and organ transplantation. Colloids may be preferred to crystalloids to maintain effective cardiac output and tissue oxygenation.
Intravenous fluid therapy may consist of infusion of crystalloids, colloids, or a combination of both. Crystalloid solutions are aqueous solutions of low-molecular-weight ions (salts) with or without glucose, whereas colloid solutions contain high-molecular-weight substances such as proteins or large glucose polymers.
Routine monitoring ECG, oxygen saturations (SpO2) and noninvasive blood pressure (NIBP) are established before induction. Further invasive cardiovascular monitoring may be established either pre- or post-induction depending on the cardiovascular stability of the patient.
Transesophageal echocardiography is the gold standard and provides continuous information on ventricular wall motion and provides the best monitoring for perioperative fluid management during liver transplantations.
Important variables affecting transfusion requirements include the severity of disease ,history of abdominal operations.Other factors identified as independent predictors of transfusion include the preoperative hematocrit value and operative time.
Liver transplantation is performed in patients of all ages. Paediatric liver transplantation has a 10 yr survival rate of 80–90%. Good success rates are also seen in the >70-yr-old population, providing they are carefully selected to take account of co-morbidities.