Campbell N; Department of Critical Care. Scottish Liver Transplant Unit, Royal Infirmary of
Edinburgh, Edinburgh, UK.
Beattie C; Gillies MA

Current Opinion in Critical Care. 32(2):179-186, 2026 Apr 01.

PURPOSE OF REVIEW: Survival rates following liver transplantation now
exceed 90% at one year. However, the patient group undergoing liver
transplantation is increasingly complex, requiring continued focus on
improving perioperative care to sustain these survival outcomes. This
review highlights recent advances in the postoperative care of the liver
transplantation patient.

RECENT FINDINGS: Modern care integrates Enhanced Recovery After Surgery
(ERAS) principles, which emphasise early mobilisation and device
minimisation. Risk stratification has become increasingly sophisticated,
with frailty and cardiopulmonary exercise testing providing powerful
prognostic information; emerging machine learning approaches may further
refine personalised risk prediction.Goal-directed haemodynamic management
is advocated, with restrictive fluid strategies and viscoelastic
haemostatic assays to minimise transfusion. Advances in graft optimisation
have expanded the donor pool: normothermic regional perfusion reduces
ischaemic cholangiopathy in donation after cardiac death grafts, while
machine perfusion systems show promise in improving early graft
function.Advanced organ support (extracorporeal membrane oxygenation)
requires careful graft-conscious management. Infection prevention
strategies include tailored prophylaxis approaches. Nutrition and
structured prehabilitation/rehabilitation programmes support recovery,
reduce complications and address persistent functional deficits.

SUMMARY: Collectively, these developments reflect a shift toward
personalised, multidisciplinary postoperative care, aimed at improving
both survival and quality of life for liver transplantation recipients.