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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 18, 2015; 7(23): 2432-2448
Published online Oct 18, 2015. doi: 10.4254/wjh.v7.i23.2432
Transoesophageal echocardiography during liver transplantation
Lesley De Pietri, Federico Mocchegiani, Chiara Leuzzi, Roberto Montalti, Marco Vivarelli, Vanni Agnoletti
Lesley De Pietri, Division of Anaesthesiology and Intensive Care Unit, Azienda Ospedaliero-Universitaria di Modena-Policlinico, 41100 Modena, Italy
Federico Mocchegiani, Roberto Montalti, Marco Vivarelli, Transplantation Unit, Polytechnic University of Marche, 60126 Ancona, Italy
Chiara Leuzzi, Unit of Interventional Cardiology, Arcispedale Santa Maria Nuova, IRCCS, 42100 Reggio Emilia, Italy
Vanni Agnoletti, Division of Anaesthesiology and Intensive Care Unit, Arcispedale Santa Maria Nuova, IRCCS, 42100 Reggio Emilia, Italy
Author contributions: De Pietri L conceived, designed and performed the review; Mocchegiani F, Montalti R, Vivarelli M and Agnoletti V revised the manuscript; Leuzzi C performed the research.
Conflict-of-interest statement: All authors of the work submitted for consideration of publication have no conflicting interests (including but not limited to commercial, personal, political, intellectual, or religious interests) to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Lesley De Pietri, Division of Anaesthesiology and Intensive Care Unit, Azienda Ospedaliero-Universitaria di Modena-Policlinico, No. 71 via del Pozzo, 41100 Modena, Italy. lesley.depietri@yahoo.it
Telephone: +39-59-4225684 Fax: +39-59-4224100
Received: April 26, 2015
Peer-review started: April 28, 2015
First decision: June 2, 2015
Revised: June 22, 2015
Accepted: September 2, 2015
Article in press: September 9, 2015
Published online: October 18, 2015
Abstract

Liver transplantation (LT) has become the standard of care for patients with end stage liver disease. The allocation of organs, which prioritizes the sickest patients, has made the management of liver transplant candidates more complex both as regards their comorbidities and their higher risk of perioperative complications. Patients undergoing LT frequently display considerable physiological changes during the procedures as a result of both the disease process and the surgery. Transoesophageal echocardiography (TEE), which visualizes dynamic cardiac function and overall contractility, has become essential for perioperative LT management and can optimize the anaesthetic management of these highly complex patients. Moreover, TEE can provide useful information on volume status and the adequacy of therapeutic interventions and can diagnose early intraoperative complications, such as the embolization of large vessels or development of pulmonary hypertension. In this review, directed at clinicians who manage TEE during LT, we show why the procedure merits a place in challenging anaesthetic environment and how it can provide essential information in the perioperative management of compromised patients undergoing this very complex surgical procedure.

Keywords: Liver transplantation, Transoesophageal echocardiography, Cirrhotic cardiomyopathy, Liver cirrhosis, Perioperative anaesthesia management

Core tip: The allocation of organs to the sickest liver transplant candidates has made their management more complex and anaesthesia for perioperative liver transplantation (LT) more challenging. Transoesophageal echocardiography, which can visualize dynamic cardiac function and overall contractility and provide real-time feedback on the adequacy of therapeutic interventions, has gained an irreplaceable role in the perioperative management of LT. We believe that echocardiography can play a key role in the care of and decision making for compromised liver transplant candidates undergoing this complex surgical procedure.