Intraoperative transesophageal echocardiography in liver transplantation: A systematic review of clinical utility in managing hemodynamic challenges and complications

A BSTRACT Liver transplantation is a life-saving procedure with significant hemodynamic instability and perioperative challenges, including massive blood loss, reperfusion syndrome, and cardiac complications. Effective intraoperative monitoring is crucial. Transesophageal echocardiography (TEE), a minimally invasive imaging modality, has emerged as a key tool for real-time monitoring. This systematic review evaluates intraoperative TEE in liver transplantation, focusing on hemodynamic monitoring, cardiac complication detection, fluid management, pulmonary hypertension, and surgical decision-making. A systematic literature search was conducted using PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar for studies published between 2010 and 2024. Search terms included “Liver Transplantation,” “Transesophageal Echocardiography,” “TEE,” and “Intraoperative Monitoring.” Relevant studies were screened, and data were synthesized through thematic analysis. Findings from the review show that TEE enables real-time hemodynamic assessment, guiding interventions for instability. It detects cardiac complications such as myocardial ischemia, arrhythmias, and valvular dysfunction, optimizes fluid resuscitation, manages pulmonary hypertension, and identifies air embolisms. In addition, it enhances intraoperative surgical and anesthetic decision-making. Intraoperative TEE is crucial for managing liver transplantation complexities. Its real-time imaging improves hemodynamic stability, enables timely interventions, and enhances patient safety, with future advancements expanding its applications.