Liver Transplant Anesthesiology
UCLA remains one of the largest liver transplant services in the country, performing in excess of 200 liver transplants per year. We transplant both adult and pediatric patients, with patients < 18 y.o. who account for about 15% of our transplants. Although the vast majority of our transplant organs are cadaveric, UCLA maintains a living-donor liver transplantation (LDLT) program for both adult-to-adult and adult-to-child donations. Additionally, the small-bowel transplantation program operates under the purview of the liver transplantation program. UCLA averages 8-13 small-bowel transplants annually. All transplant anesthetics are provided by a dedicated group of anesthesiologists who form a subspecialty group within the department. As a group, we are particularly involved in research on perioperative management of liver transplant patients.
The liver transplantation service also performs hepato-biliary surgeries, including major and minor hepatic resections, vascular procedures for portal decompression, and biliary drainage procedures. Although we generally provide anesthesia for these procedures, they are not exclusively our domain as are transplants.
Because the effects of end-stage liver disease involve every organ system, most of the patients who present for liver transplantation have, in addition to severe hepatic dysfunction, multi-organ failure. It is not uncommon for patients to arrive in the operating room intubated, on multiple vasoactive infusions, and receiving hemofiltration or dialysis. Depending on the patient's anatomy and physiology, the surgical procedure may or may not involve partial veno-venous bypass, but the patient will regardless experience large fluid shifts and dramatic changes in hemodynamics. In addition to placing and utilizing the PAC and TEE for hemodynamic management, residents will also learn to manage large-volume fluid and blood resuscitation, and to treat acid-base, electrolyte, and hemostatic abnormalities. This intraoperative experience is augmented both pre-and post-operatively in the Liver ICU, which is one of the Critical Care Medicine resident rotations.