Exploring the milestones in anaesthesia that made liver transplantation a realistic therapeutic option for fatal liver failure: A story of 4 decades in a single centre

Abstract

Liver transplantation has evolved from an initial experimental procedure to a successful treatment for end-stage liver disease. This study explored milestones in liver transplantation anaesthetic care that contributed to improved outcomes in a single centre.

An analysis of transplant mortality outcomes was performed on adults and children who underwent liver transplantation between 1988 and 2019. A qualitative enquiry involved a thematic analysis of the opinions of retired and current anaesthetists.

Four overarching themes were identified:

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  The evolving status of liver transplantation service

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  The importance of multi-disciplinary teams

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  The surgical process

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  The experimental nature of liver transplantation

Of 5398 liver transplants performed, 23% were paediatric. Kaplan-Meier survival curves for adult and paediatric recipients showed a 1-year survival probability of over 90%. The 25-year survival was 42% and 80%, respectively.

Improved management of (a) intraoperative blood loss through the use of techniques such as preoperative coagulation screening, intraoperative blood salvage, and the use of blood transfusions (b) enhanced intraoperative monitoring through the use of techniques such as continuous echocardiography, transesophageal echocardiography, and pulmonary artery catheters and (c) the establishment of dedicated theatre space and staff for liver transplantation achieved through the construction of new dedicated liver transplantation units and the hiring of specialized staff were the key anaesthetic milestones that contributed to improved patient outcome following liver transplantation.