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Management of the critically ill liver failure patient

surpassing our limitations to reach transplantation

Mobley, Constance M.a,b; Saharia, Ashisha,b

Current Opinion in Organ Transplantation: April 2018 - Volume 23 - Issue 2 - p 145–150
doi: 10.1097/MOT.0000000000000518
LIVER TRANSPLANTATION: Edited by R. Mark Ghobrial
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Purpose of review Patients with liver failure and liver-related diseases are often critically ill. Here, we review advances in donor organ management, tools for patient selection and highlight ICU management of liver transplant (LT) recipients. A focused discussion on the impact each of these factors have on critical care management of liver failure patients is presented.

Recent findings Artificial liver assist devices to increase donor organ utilization are broadening the potential for transplantation of critically ill patients. Additionally, prognostication tools continue to improve and identify patients salvageable with transplantation despite severely deranged physiology. Most importantly, early recognition of liver failure combined with proactive critical care management reduces the incidence of failure-to-rescue and increases the likelihood of transplantation.

Summary Liver transplantation is often the only hope for cure, and despite the presence of profound physiologic disturbances surgery remains the goal. In this review, we cover topics key in ICU management of LT recipients. A focused discussion on development of artificial liver assist devices to increase donor organs, prognostic scoring systems to define appropriate transplant recipients, critical care management of liver failure physiology, and bridging modalities and supportive measures are presented.

aDivision of Surgical Critical Care, Department of Surgery

bSherrie and Alan Conover Centre for Liver Disease and Transplantation, Houston Methodist Hospital, Houston, Texas, USA

Correspondence to Constance M. Mobley, MD, PhD, FACS, 6550 Fannin Street, SM1601, Houston, TX 77030, USA. Tel: +1 713.441.1590; fax: +1 713.790.6470; e-mail: cmmobley@houstonmethodist.org

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