Contemporary anesthesia management for liver transplantation: a comparison of American and European methods

ABSTRACT

This review article compares the organization of liver transplantation programs, anesthesia management and postoperative care in the United States and Europe. Liver transplantation is a definitive treatment for end-stage liver disease. The procedure is extremely complex and requires excellent surgical technique and experienced anesthesiologists who are able to provide precise management. Liver transplantation programs, which first started in the United States and a few years later in Europe, have quickly been able to achieve remarkable results. In the United States one organization, the United Network for Organ Sharing [UNOS] is responsible for the allocation of organs and data collection; in Europe there are various organizations with different levels of cooperation. The major difference between anesthesia management in the United States and Europe is the number of medications available for coagulation improvement. Substances such as prothrombin complex concentrate, fibrinogen, and antithrombin III allow for a greater flexibility in European anesthesia management. Thromboelastography, which is routinely used in the United States for overseeing coagulation, is now increasingly being used in Europe, and seems to be highly effective in providing precise information about coagulation. The overall ICU stay in Europe is longer than in the United States, and services such as maintenance of critical care, immunosuppression and nutrition are not separated in Europe. Despite these differences in liver transplantation programs, overall one-year patient survival rate is similar in the United States and in Europe, exceeding 85% in both