Why the study?
Intraoperative management during orthotopic liver transplantation is challenged by hemodynamic instability and adverse outcomes, and there is no consensus on the best approach to intraoperative monitoring.
Does intraoperative transesophageal echocardiography improve hemodynamic monitoring and complication detection in patients undergoing orthotopic liver transplantation?
Does intraoperative transesophageal echocardiography improve hemodynamic monitoring and complication detection in patients undergoing orthotopic liver transplantation?
Intraoperative TEE is recommended during orthotopic liver transplantation to monitor hemodynamics, guide fluid and inotrope therapy, and rapidly diagnose life-threatening complications.
May warrant closer intraoperative BP monitoring in OLT; leaves open whether optimization improves outcomes.
The intraoperative management of patients undergoing orthotopic liver transplantation (OLT) is influenced by the cardiovascular manifestations typically found in the context of end-stage liver disease, by the presence of concomitant cardiovascular disease, and by the significant hemodynamic changes that occur during surgery. Hypotension and intraoperative blood pressure fluctuations during OLT are associated with liver graft dysfunction, acute kidney failure, and increased risk of 30-d mortality. Patients also frequently present hemodynamic instability due to various causes, including cardiac arrest. Recent evidence has shown transesophageal echocardiography (TEE) to be a useful minimally invasive monitoring tool in patients undergoing OLT that gives valuable real-time information on biventricular function and volume status and can help to detect OLT-specific complications or situations. TEE also facilitates rapid diagnosis of life-threatening conditions in each stage of OLT, which is difficult to identify with other types of monitoring commonly used. Although there is no consensus on the best approach to intraoperative monitoring in these patients, intraoperative TEE is safe and useful and should be recommended during OLT, according to experts, for assessing hemodynamic changes, identifying possible complications, and guiding treatment with fluids and inotropes to achieve optimal patient care.
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Arcas-Bellas et al. (2024) studied this question.
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