Anaesthesia for liver transplantation at King Hussein medical centre: an overview of 70 cases


  • Ashraf Fadel Mohammad Department of Anaesthesia and Intensive Care at Jordanian Royal Medical Services, Amman, Jordan
  • Ghazi S. Aldehayat Department of Anaesthesia and Intensive Care at Jordanian Royal Medical Services, Amman, Jordan
  • Qais K. Al-Qusus Department of Anaesthesia and Intensive Care at Jordanian Royal Medical Services, Amman, Jordan
  • Mohammad A. Khasawneh Department of Anaesthesia and Intensive Care at Jordanian Royal Medical Services, Amman, Jordan
  • Yaser A. Alghoul Department of Anaesthesia and Intensive Care at Jordanian Royal Medical Services, Amman, Jordan



Anesthesia, Indications, Liver, Recipient, Transfusion, Transplantation


Background: To review the indications, patients' demographics, and anaesthetic protocol and to analyze perioperative complications of liver transplantation surgery.

Methods: Retrospective analysis of 70 cases of LT in the period between June 2004 and October 2020 at King Hussein medical centre. Preoperative factors such as patients' demographics, age, gender, etiology of hepatic pathology, laboratory investigations, model for end-stage liver disease scores, duration of surgery and type of liver donation were recorded. Intraoperative factors such as anaesthetic and surgical protocols, need of blood product transfusions and haemodynamic monitoring were analyzed. Postoperative tracking of patients' complications and outcomes was done.

Results: 68 living donor and two cadaveric LT procedures. Male to female ratio was 2.9:1.The age of LT recipients ranged from 3 to 62 years with an average age of 38.45 years. Their body weights ranged from 13 to 100 kg with mean body weight of 67.03 kg. Most common indication was cryptogenic liver cirrhosis (21.4%), followed by cirrhosis due to viral hepatitis B (15.7%). Autoimmune hepatitis was an indication in 11.4% and hepatitis C liver cirrhosis in 10%. All living donors were closely related. Right hepatic lobe graft was used in 85.7% of transplantations. Average red cells concentrate (RCC) transfused (units) was 3.1±3.97 (mean±SD). Duration of surgery (hours) was 12.5±2.4 (mean±SD). Fast track LT with extubation in theatre was done in 37 LT recipients (52.9%). Readmission to operative theatre was needed in 5 recipients (7.14%). Most common long term complications were biliary leak (20%), biliary stenosis (14.2%) and recurrence of primary disease (12.9%).

Conclusions: Transplantation from living donors was by far more common in our study population. Majority of recipients were male and cryptogenic liver cirrhosis was the most common indication. Right hepatic lobe graft was used mostly. Biliary leak was the most common postoperative complication. Surgical time duration and blood products transfusion decreased significantly over years since the start of LT program.

Author Biography

Ashraf Fadel Mohammad, Department of Anaesthesia and Intensive Care at Jordanian Royal Medical Services, Amman, Jordan

Department of cardiac anesthesia

Senior Specialist


Mahmud N. Selection for Liver Transplantation: Indications and Evaluation. Curr Hepatology Rep. 2020;19:203-12.

Kim WR, Lake JR, Smith JM, Schladt DP, Skeans MA, Harper AM, et al. OPTN/SRTR 2016 annual data report: liver. Am J Transplant. 2018;18(1):172-253.

Meirelles RF, Salvalaggio P, Rezende MB, Evangelista AS, Guardia BD, Matielo CE, et al. Liver transplantation: history, outcomes and perspectives. Einstein (Sao Paulo). 2015;13(1):149-52.

Starzl TE, Marchioro TL, Vonkaulla KN, Hermann G, Brittain RS, Waddell WR. Homotransplantation of the liver in humans. Surg Gynecol Obstet. 1963; 117:659-76

Song AT, Avelino-Silva VI, Pecora RA, Pugliese V, D'Albuquerque LA, Abdala E. Liver transplantation: fifty years of experience. World J Gastroenterol. 2014 May 14;20(18):5363-74.

Atalan HK, Gucyetmez B, Donmez R, Kargi A, Polat KY. Advantages of epidural analgesia on pulmonary functions in liver transplant donors. Transplant Proc. 2017;49(6):1351-6.

Koul A, Pant D, Rudravaram S, Sood J. Thoracic epidural analgesia in donor hepatectomy: An analysis. Liver Transpl. 2018;24(2):214-21.

Esteve N, Ferrer A, Sansaloni C, Mariscal M, Torres M, Mora C. Epidural anesthesia and analgesia in liver resection: Safety and effectiveness. Rev Esp Anestesiol Reanim. 2017;64(2):86-94.

Clarke H, Chandy T, Srinivas C, Ladak S, Okubo N, Mitsakakis N, et al. Epidural analgesia provides better pain management after live liver donation: a retrospective study. Liver Transpl. 2011;17(3):315-23.

Feltracco P, Brezzi ML, Barbieri S, Serra E, Milevoj M, Ori C. Epidural anesthesia and analgesia in liver resection and living donor hepatectomy. Transplant Proc. 2008;40(4):1165-8.

Blonski W, Siropaides T, Reddy KR. Coagulopathy in liver disease. Curr Treat Options Gastroenterol. 2007;10(6):464-73.

Intagliata NM, Davis JPE, Caldwell SH. Coagulation pathways, hemostasis, and thrombosis in liver failure. Semin Respir Crit Care Med. 2018; 39(5):598-608.

Li J, Han B, Li H, Deng H, Méndez-Sánchez N, Guo X, Qi X. Association of coagulopathy with the risk of bleeding after invasive procedures in liver cirrhosis. Saudi J Gastroenterol. 2018;24(4):220-7.

Hausken J, Haugaa H, Hagness M, Line PD, Melum E, Tønnessen TI. Thoracic epidural analgesia for postoperative pain management in liver transplantation: A 10-year study on 685 liver transplant recipients. Transplant Direct. 2021;7(2): e648.

Sarkar M, Watt KD, Terrault N, Berenguer M. Outcomes in liver transplantation: does sex matter? J Hepatol. 2015;62(4):946-55.

Darden M, Parker G, Anderson E, Buell JF. Persistent sex disparity in liver transplantation rates. Surgery. 2021;169(3):694-9.

Allen AM, Heimbach JK, Larson JJ, Mara KC, Kim WR, Kamath PS, et al. Reduced access to liver transplantation in women: role of height, meld exception scores, and renal function underestimation. Transplantation. 2018;102(10): 1710-6.

Rudnick MR, Marchi LD, Plotkin JS. Hemodynamic monitoring during liver transplantation: A state of the art review. World J Hepatol. 2015;7(10):1302-11.

Krenn CG, De Wolf AM. Current approach to intraoperative monitoring in liver transplantation. Curr Opin Organ Transplant. 2008;13(3):285-90.

Della Rocca G, Brondani A, Costa MG. Intraoperative hemodynamic monitoring during organ transplantation: what is new? Curr Opin Organ Transplant. 2009;14(3):291-6.

Whitener S, Konoske R, Mark JB. Pulmonary artery catheter. Best Pract Res Clin Anaesthesiol. 2014; 28(4):323-35.

Vilchez-Monge AL, Tranche Alvarez-Cagigas I, Perez-Peña J, Olmedilla L, Jimeno C, Sanz J, Bellón Cano JM, et al. Cardiac output monitoring with pulmonary versus transpulmonary thermodilution during liver transplantation: interchangeable methods?. Minerva Anestesiol. 2014;80(11):1178-87.

Robin E, Costecalde M, Lebuffe G, Vallet B. Clinical relevance of data from the pulmonary artery catheter. Crit Care. 2006;10(3):S3.

Schmid B, Fink K, Olschewski M, Richter S, Schwab T, Brunner M, et al. Accuracy and precision of transcardiopulmonary thermodilution in patients with cardiogenic shock. J Clin Monit Comput. 2016; 30(6):849-56.

Quintana-Villamandos B, Barranco M, Fernández I, Ruiz M, Del Cañizo JF. New advances in monitoring cardiac output in circulatory mechanical assistance devices. A validation study in a porcine model. Front Physiol. 2021;12:634779.

Lamia B, Kim HK, Severyn DA, Pinsky MR. Cross-comparisons of trending accuracies of continuous cardiac-output measurements: pulse contour analysis, bioreactance, and pulmonary-artery catheter. J Clin Monit Comput. 2018;32(1):33-43.

Mehta Y, Arora D. Newer methods of cardiac output monitoring. World J Cardiol. 2014;6(9): 1022-9.

Willars C, Dada A, Hughes T, Green D. Functional haemodynamic monitoring: The value of SVV as measured by the LiDCORapid™ in predicting fluid responsiveness in high risk vascular surgical patients. Int J Surg. 2012;10(3):148-52.

Blendis L, Wong F. The hyperdynamic circulation in cirrhosis: an overview. Pharmacol Ther. 2001; 89(3):221-31.

Whiting D, DiNardo JA. TEG and ROTEM: technology and clinical applications. Am J Hematol. 2014;89(2):228-32.

Hawkins RB, Raymond SL, Hartjes T, Efron PA, Larson SD, Andreoni KA, et al: The perioperative use of thromboelastography for liver transplant patients. Transplant Proc. 2018;50(10):3552-8.

Wang SC, Shieh JF, Chang KY, Chu YC, Liu CS, Loong CC, et al. Thromboelastography-guided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: randomized clinical trial. Transplant Proc. 2010; 42(7):2590-3.

Badenoch A, Sharma A, Gower S, Selzner M, Srinivas C, Wąsowicz M, et al. The effectiveness and safety of tranexamic acid in orthotopic liver transplantation clinical practice: a propensity score matched cohort study. Transplantation. 2017; 101(7):1658-65.

Boylan JF, Klinck JR, Sandler AN, Arellano R, Greig PD, Nierenberg H, et al. Tranexamic acid reduces blood loss, transfusion requirements, and coagulation factor use in primary orthotopic liver transplantation. Anesthesiology. 1996;85(5):1043-8.

Wu J, Rastogi V, Zheng SS. Clinical practice of early extubation after liver transplantation. Hepatobiliary Pancreat Dis Int. 2012;11(6):577-85.

Aneja S, Raina R. Immediate postoperative extubation after liver transplantation at our centre: A report of two cases. Indian J Anaesth. 2011;55(4): 392-4.






Original Research Articles