Liver Transplantation

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).