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Abstract Liver transplantation is the definitive treatment for acute and chronic irreversible liver failure; for syndromes not manifesting with end-stage liver disease (ESLD), including polycystic liver disease and metabolic diseases; for some malignancies confined to the liver; and for cholestatic liver diseases. Of accepted contraindications to orthotropic liver transplantation (OLT), those of particular interest to anesthesiologists include severe cardiopulmonary conditions, such as symptomatic coronary artery disease (CAD), severe systolic dysfunction, advanced cardiomyopathy, severe valvular heart disease, severe pulmonary hypertension, sustained intracranial pressure greater than 50 mm Hg, and uncontrolled sepsis, according to the most recent guidelines of the American Association for the Study of Liver Diseases (AASLD). (120( An anesthetic and critical care evaluation, as a part of a multidisciplinary team assessment, should precede the acceptance of patients to the waiting list. The goals of this assessment are to appraise suitable candidates based on functional status and comorbidities and design an individualized, patient-specific perioperative treatment plan. For patients whose comorbidities present a prohibitive operative risk, alternative treatments should be considered. (72,127) Intensive care management of liver transplanted patients requires sophisticated monitoring and multi-disciplinary approach. For an ideal intensive care treatment today, an experienced team (doctor, nurse, physiotherapist, etc.) and advanced intensive care/institution facilities (diagnostic-treatment devices, operating room, blood bank, pharmacy etc.) are mandatory. (136) |