Immediate Postoperative Care

There are three major considerations in the immediate postoperative period: 1) liver function, 2) postoperative bleeding, and 3) general considerations.

1. Liver Function

One of the most disastrous complications following liver transplantation is primary nonfunction (PNF). PNF needs to be differentiated from graft dysfunction which encompasses a spectrum ranging from mild graft dysfunction, manifested by elevated liver enzymes and poor early synthetic function, to severe dysfunction manifested by prolonged synthetic dysfunction, some degree of hemodynamic instability, and associated multiorgan dysfunction.22 This end of the dysfunction spectrum along with PNF require consideration of urgent retransplantation, whereas mild to moderate dysfunction require close observation and supportive therapy. The appearance of the liver following reperfusion, the production of bile intraoperatively, and the hemodynamic status of the recipient provide intraoperative evidence of liver function (Table 9.15).

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