Anaesthesia for liver transplantation: experience at a teaching hospital.

OBJECTIVE: To assess the anaesthetic aspects of liver transplantation. DESIGN: Retrospective study. SETTING: University teaching hospital, Hong Kong. PATIENTS: The first 55 patients who received liver transplantations between 5 October 1991 and 14 June 1997. MAIN OUTCOME MEASURES: The anaesthetic technique used; indications for liver transplantation and type of graft transplanted; survival rate; duration of anaesthesia and surgical starting time; intra-operative changes associated with major transfusion; frequency of hypothermia, coagulopathy, and reperfusion; frequency of use of cell saver devices, veno-venous bypass, and a rapid infusion system; and associated complications. RESULTS: All patients received general anaesthesia with rapid sequence induction. Most adult recipients had cirrhosis from various causes, whereas biliary atresia was the most common condition in the paediatric population. Both cadaveric and living-related liver transplantations were performed, and the overall 1-year survival rate of patients who received a transplantation before June 1996 was 85%. Veno-venous bypass was used in 84% of adults, but in none of the paediatric patients; a cell saver device was used for all adult patients and 92% of paediatric patients. All transplant recipients had acidosis, hypothermia, and hypotension during the operation. CONCLUSIONS: Liver transplantation is no longer experimental. It is the therapeutic option for patients with chronic liver failure. Good anaesthetic support is an essential element of a liver transplantation service.