**1. Introduction**

332 Liver Transplantation – Basic Issues

Zardi, E. M., Abbate, A., Zardi, D. M., Dobrina, A., Margiotta, D., Van Tassell, B. W., Afeltra,

*Cardiology*, Vol. 56, No. 7, Aug 2010, pp. 539-49, 20688208

A., & Sanyal A. J. (2010). Cirrhotic cardiomyopathy. *Journal American College* 

Liver transplantation, is the replacement of unhealthy liver with a new liver allograft. This surgical procedure is now widely common all over the world in various medical centers. The major limiting factors of this surgery is the lack of available donors and decreased chance of appropriate patient selection. Anesthetic management of organ donors includes intensive management of heart beating and brain dead donors; however the augmentation of waiting list for liver and inadequate cadaveric organs resulted in elevated living donor transplantation rates especially for the critically ill patients who will not survive waiting until a brain dead donor is provided, resulting in the growing experience in anesthetic techniques for the management of living donors (Pickett et al, 1994; Lutz et al, 2003).

The most common indications for orthotopic liver transplantation (OLT) in adults are alcoholic cirrhosis, chronic cirrhosis due to hepatitis C, primary biliary cirrhosis and primary sclerosing cholangitis. The most common indication for OLT in pediatric patients is biliary atresia, followed by metabolic disorders (alfa-1 antitrypsin deficiency, Wilson's disease, tyrosinemia, Crigler-Najjar type-1 syndrome), fulminant hepatic failure, cryptogenic cirrhosis, neonatal hepatitis, and malignancy.

The association of liver failure with pathologic status of all other organ systems requires a thorough examination of the liver host and a fastidiously scheduled anaesthesia. A detailed monitoring of the patient and a careful therapeutic concept is required to meet the extraordinary conditions during liver transplantation. This report sheds light on the anaesthesiological approach of the liver transplantation and summarizes suitable therapeutic options.
