Graft support

Adequate graft oxygenation is essential. The liver receives its blood supply from both the portal vein and the hepatic artery, and the main determinant of flow is cardiac output. Therefore systemic hemodynamics are important. Prostacylin and ^-acetylcysteine have been used in fulminant hepatic failure and primary graft non-function to improve the hepatic microcirculation, alter cytokine release, modulate NO production, and enhance resistance to oxidant injury ( Harrison ยง1.3.1 19.9,1).

Artificial liver support in the form of an extracorporeal liver-assist device containing living hepatocytes is still a research tool. Retransplantation remains the only option for graft failure.

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