The Division of Liver Transplant Anesthesiology at UCLA began in 1984, when the first liver transplant was performed at UCLA. At the time, UCLA was the only liver transplant program in the western U.S. Since 1984, UCLA has performed 6000 liver transplants, making UCLA the most active program in the world. The division provides specialized care for liver transplant and hepato-pancreato-biliary (HPB) cases at UCLA’s main quaternary-care teaching hospital, Ronald Reagan Medical Center.
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Our service provides care for solid organ abdominal transplantation including liver, small bowel, multi-visceral and combined liver-kidney recipients. Both adult and pediatric liver and bowel transplant patients are cared for by the service. HPB patients undergoing elective surgery are scheduled with the liver transplant anesthesiology service. Common procedures for HPB patients include resection of hepatocellular carcinoma and resection of hepatic metastases of colon cancer. Additional cases performed for end-stage liver disease patients include shunt procedures such as TIPS, liver biopsies, ERCP, and tunneled central venous access including ports to name a few.
The acuity of these patients is unparalleled. Arterial lines, pulmonary artery catheters and transesophageal echocardiography (TEE) are used in many patients. In room, point-of-care laboratory analysis is available for hemoglobin, electrolytes, glucose and blood gases; coagulation studies, including viscoelastic testing (thromboelastometry) is available in the nearby operating room laboratory.
Transfusion medicine, echocardiography and liver disease are core didactic topics. LT anesthesiology faculty are frequent presenters and authors on these topics, as well as transplantation. Close collaboration occurs between the blood bank, cardiothoracic anesthesia, critical care, cardiology and hepatology, in addition to transplant surgery.
We maintain a prospective database of every liver transplant case with a focus on blood products administered, coagulation abnormalities, echocardiography findings, and metabolic derangements. This database has elucidated associations that only a high-volume center can discern, and serves as the source of a number of published studies in journals that include Liver Transplantation (Pan 2014; 20: 823) and Am J Transpl (Xia 2015; 15: 687).
Another area of focus for our service is the pre-transplant cardiac evaluation, which remains controversial. UCLA served as the coordinating site for an evaluation of coronary angiography as a screening tool for liver transplant candidates that was published in the American Journal of Transplantation (Wray 2013; 13: 184), and a definitive article on the role of myocardial perfusion imaging in liver transplant candidates in Am J Cardiol (Bhutani 2013; 111: 1057).
Active collaborations with the UCLA Division of Cardiology are investigating the role of left atrial volume index in predicting post-transplantation outcomes. The physician anesthesiologists on our service are widely recognized as experts in the management of high MELD (model for end-stage liver disease) transplant recipients. The service encourages faculty to participate in research, and several faculty members have advanced degrees in clinical research. Basic perioperative TEE certification is also encouraged.
Faculty are active contributors to fundamental texts, providing chapters on transplantation and care of the liver disease patients for over a dozen books, including Miller’s Basics of Anesthesia 7th edition (2017), Miller’s Anesthesia 8th edition (2015), Clinical Anesthesia 8th edition (Barash, ed., 2017) and UpToDate Anesthesia online (2017). In addition, faculty contribute to multidisciplinary consensus-based guidelines (J Hepatology 2016; 64: 717).
The primary goal of the one-year liver transplant anesthesia fellowship is to prepare participants for an academic career that focuses on the perioperative care of high-acuity abdominal transplant patients. Important secondary goals include training in basic perioperative TEE (leading to basic TEE certification) and research in the domains of transplantation, transfusion, and/or coagulation monitoring. See the Fellowships section of our website for a complete list of the fellowship goals and objectives.
Prospective patients and their families are referred to the “For Patients & Families” section of our website for more information about anesthesia and surgery. General information about the admission process, lodging, and other resources may be found on the “For Patients & Visitors” area of the main UCLA Health website. Patients who are listed for transplantation are evaluated and examined in person by the Liver Transplant Anesthesiology service.