/ Prof Dave Cosgrave
Locum Consultant Anaesthetist, Queen Charlotte’s, Hammersmith and Charing Cross Hospitals, Imperial College Healthcare NHS Trust, London
Honorary Research Fellow, St Vincent’s University Hospital, Elm Park, Dublin 4.
David was awarded Certification of Specialist Registration in Anaesthesia in July 2016, and has completed fellowships in hepatobiliary and liver transplant anaesthesia, (St Vincent’s University Hospital, Dublin) obstetric anaesthesia (The Rotunda Hospital, Dublin) and renal and pancreatic transplant (The Hammersmith Hospital, London).
He has recently submitted his thesis for examination for Doctorate of Medicine in University College Dublin, on the topic of Intrathecal morphine usage in major open hepatobiliary surgery, based around the randomised controlled trial, “The NAPRESSIM Trial, The use of low dose prophylactic naloxone infusion to prevent respiratory depression with intrathecal morphine in elective hepatobiliary surgery,” results of which will be published in the coming months. He has also contributed to publications on this topic including an online tutorial, audit and the trial protocol for The NAPRESSIM Trial.
David is married with 2 young daughters to keep him busy outside of work, and enjoys cooking and running when time allows.
Liver transplant is the treatment of choice for liver failure, and no alternative treatment currently exists. Hepatic failure may present as acute or fulminant, or may be of slow onset, with cirrhosis and gradual progression to end stage.
Candidates for liver transplant are assessed on scoring systems such as MELD and UKELD, and discussed in a multidisciplinary environment prior to listing for transplant.
The preoperative assessment of these patients includes routine assessment of the patient’s overall medical fitness, along with assessment of specific liver disease related co-morbidities, including hepatorenal syndrome, hepatopulmonary syndrome, portopulmonary hypertension, coagulation disturbance and cirrhotic cardiomyopathy.
Intraoperative care of recipients is divided into 3 phases: preanhepatic, anhepatic and reperfusion phase.
Each phase brings its own complexity, with risks of metabolic disturbance, haemodynamic instability, coagulation disturbance and major haemorrhage involved to varying degrees depending on the health of the recipient, and the quality of the graft.
Assessment and perioperative management of transplant recipients will be discussed.
1. Dalal, A., Anesthesia for liver transplantation. Transplant Rev (Orlando), 2016. 30(1): p. 51-60.
2. Fabbroni, D. and M. Bellamy, Anaesthesia for hepatic transplantation. Continuing Education in Anaesthesia Critical Care & Pain, 2006. 6(5): p. 171-175.
3. Saner, F.H., et al., Delicate balance of bleeding and thrombosis in end-stage liver disease and liver transplantation. Digestion, 2013. 88(3): p. 135-44.
4. Roullet, S., et al., Management of bleeding and transfusion during liver transplantation before and after the introduction of a rotational thromboelastometry-based algorithm. Liver Transpl, 2015. 21(2): p. 169-79.