**1. Introduction**

In the past years, liver transplantation (LT) has made leaps and evolved from an endeavor in specialized centers to a worldwide definitive and gold standard treatment of the end-stage liver disease (ESLD), acute liver failure, and various cancer types [1, 2].

The advances in perioperative management, including the improvement of surgical techniques, preservation solutions, perioperative management, and monitoring, as well as advances in immunosuppression and postoperative care have led not only to an increased number of transplantations but also to better outcomes [2]. According to recent studies in the United Kingdom, the 1- and 5-year survival rate for liver transplant recipients has reached 92 and 80%, respectively [3]. However, there are still certain challenges in LT. Scarcity of allografts and disparity between supply and demand has led the transplantation community to expand the donor pool by utilizing split grafts, allografts from living donors after cardiac death and including marginal donors of older age and with extended steatosis [4].

Additionally, recipients are sicker, given that priority of graft allocation is based on higher MELD scores, older and with co-morbidities such as metabolic syndrome, cardiac disease, and diabetes mellitus [5, 6]. Postoperative liver transplant patient care requires careful accounting of the recipient's pre-existing pathophysiology, intraoperative events, and donor's quality. Moreover, the implanted liver represents a unique biological entity that has undergone physiological changes and has to adapt to a new environment. This donor-recipient interaction is the key of a successful transplantation [7].

The intensivist's role is essential as a multifaceted approach is critical for optimal transplantation outcomes. The main hurdles to tackle are early recognition and immediate treatment of the hemodynamic and metabolic disorders, restoration of intravascular volume, avoidance of coagulation disorders, optimization of organs function affected by hepatic failure, prophylaxis and treatment of infections, early enteral nutrition, and evaluation of graft function. Technological advances offer the possibility of continuous cardiovascular and allograft function monitoring facilitating improved endpoint results.
