A practical approach to anaesthesia for paediatric liver transplantation

Abstract

Anaesthesia for paediatric liver transplantation requires meticulous attention to detail, an understanding of the disease process leading up to the need for transplantation, and an awareness of the haematological, biochemical, and multi-organ consequences of this operation. In the past 20 years, significant advances in surgical techniques, organ procurement and preservation, immunosuppression, anaesthetic management and monitoring, and postoperative care in the intensive care unit have contributed to improved outcomes of both the graft and the patient. In more recent years, the use of reduced size and living related organs has increased the donor pool for infants and children. Paediatric liver transplantation in South Africa, up until the present time, has been centered at the Red Cross Children's Hospital in Cape Town, and survival rates here are comparable with international figures. This paper highlights the preoperative problems which face the anaesthetist, emphasises the importance of good planning and preparation for the intraoperative procedure, simplifies the surgical technique of the operation, and stresses the value of a multidisciplinary approach to the child requiring liver transplantation.

Southern African Journal of Anaesthesia and Analgesia Vol. 12(1) 2006: 11-15