In this review, the authors highlight recent advances in the care of liver transplantation patients important to anesthesiologists. The number of liver transplants continues to increase annually, and the challenges of managing complex patients require knowledge of the unique pathophysiology of end-stage liver disease. Regional anesthesia, specifically fascial plane blocks, allows for improved nonopioid pain control in recipients and potentially decreases length of stay. The use of transesophageal echocardiography (TEE) in liver transplantation allows for real-time assessment of cardiac function. Diagnosing the dreaded intracardiac thrombus with TEE during liver transplantation is essential for prompt treatment. Additionally, existing structural cardiac disease may lead to left ventricular outflow obstruction and require specific treatment modalities. Again, the use of TEE is important in making this diagnosis. Combined heart-liver transplantations are complex surgical procedures. The use of mechanical circulatory support may be necessary in some cases and anesthesiologists should understand the underlying disease process to inform the use of such support. Finally, living donation for liver transplantation remains an option for directed or anonymous donation. Anesthesiologists' role in managing donors starts in the evaluation process through postoperative pain management and showcases the broad skillset of anesthesiologists.
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