Trans-esophageal echocardiographic assessment of hepatic vasculature in patients undergoing living donor liver transplantation – A Prospective Observational study.

Liver transplantation is considered a standard of care and life-saving procedure for patients suffering from end-stage liver disease (ESLD). Due to cirrhotic cardiomyopathy, these patients usually have cardiac dysfunction which is not detected on routine testing but manifests during stress conditions of surgery. The expanding role of transesophageal echocardiography (TEE) in intraoperative monitoring is now increasing gradually and it is being used away from the context of cardiac surgeries alone. The American Association for anesthetists on liver diseases has recommended that TEE should be used for all orthotropic liver transplant cases. Similarly, the European association of echocardiography has also recommended for use of TEE in all liver transplant cases. TEE can be used not only to monitor cardiac changes but can also give valuable information about other organs such as the lungs and liver. In a case report by Khurmi et al,  they used TEE to diagnose hepatic venous and IVC thrombus intra-operatively during liver transplant surgery. The anatomic proximity of the distal esophagus and gastric antrum to the hepatic vein, portal vein, and inferior vena cava make TEE an idol monitor for their proper assessment during liver transplant surgery. Hence, in this study, we aim to evaluate the hepatic vein, portal vein, and inferior vena cava by TEE during living donor liver transplant surgery.