The strategy of extrahepatic organs management in early period after adult liver transplantation
10.16139/j.1007-9610.2023.05.04
- VernacularTitle:成人肝移植术后早期肝外脏器功能管理策略
- Author:
Yuxiao DENG
1
;
Xianyuan ZHAO
;
Yuan GAO
Author Information
1. 上海交通大学医学院附属仁济医院重症医学科,上海 200127
- Keywords:
Liver transplantation;
Extrahepatic organ;
Intensive care
- From:
Journal of Surgery Concepts & Practice
2023;28(5):415-419
- CountryChina
- Language:Chinese
-
Abstract:
With the improvements in surgical technique,the indications for liver transplantation(LT)are being expanded to more complex and severe patients,who not only have liver function in the terminal stage,but also extrahepatic organs involve of varying degrees dysfunction.It was demonstrated that the strategy of extrahepatic organs management in early period after LT was associated with improving recovery.This paper summarized the strategy of extrahepatic organs management in early period after adult LT.Continuing to monitor system hemodynamics is helpful for stable graft perfusion.It is necessary to manage derangements of preload,myocardial contractility,and afterload.Early postoperative extubation is recommended by current guidelines.Routine screening pulmonary complications may help weaning from the ventilator.The diagnosis of acute kidney injury(AKI)after LT has been reported to using Kidney Disease:Improving Global Outcomes(KDIGO)criteria,a delayed calcineurin inhibitor initiation strategy may be beneficial for renal protection.Currently,there is no consensus on timing of renal replacement therapy initiation in patients with AKI.Patients with cirrhosis and a history of hepatic encephalopathy(HE)displays impaired neurological recovery,the diagnosis of HE is crucial and challenging.
