Perioperative Management of the Patient with End-Stage Liver Disease

End-stage liver disease is associated with increased perioperative morbidity and mortality. This narrative review provides a summary of perioperative concerns and management of patients with end-stage liver disease.

Model for end-stage liver disease (MELD) 3.0 is the most updated version of the MELD score which is used as both a prognostic score to prioritize organ allocation and to assess the severity of liver disease. The American Association for the Study of Liver Disease and The American Gastroenterological Association have provided updated guidelines on procedural bleeding and transfusion management in patients with liver disease. There is controversy on the issue of prophylactic transfusion for target thresholds prior to surgery.

Preoperative risk assessment is dependent on the severity of liver disease, type of surgery, urgency of surgery, age, and comorbidities. Patients with end-stage liver disease may need higher acuity of care in the postoperative period.