Includes bibliographical references and index.

No place in the world is more closely identifi ed with Critical Care Medicine
than Pittsburgh. In the late 1960s, Peter Safar and Ake Grenvik pioneered the
science and practice of critical care not just in Pittsburgh but around the world.
Their multidisciplinary team approach became the standard for how ICU care is
delivered in Pittsburgh to this day. The Pittsburgh Critical Care Medicine series
honors this tradition. Edited and largely authored by University of Pittsburgh faculty, the content reflects best practice in critical care medicine. The Pittsburgh
model has been adopted by many programs around the world, and local leaders
are recognized as world leaders. It is our hope that through this series of concise
handbooks, a small part of this tradition can be passed on to the many practitioners of critical care the world over When I was approached by Dr. John Kellum to write this book, I was a little
hesitant. What could I possibly add to the field by writing this book? There are
so many excellent books in critical care, anesthesia, gastroenterology, and transplantation surgery. After initial thought, I concluded that writing a book that
takes readers through the long journey of intensive patient care management of
multiple medical and surgical problems before and after transplant would be a
valuable addition to the critical care literature.
With advances in technology and organization of health-care delivery, many
patients with end-stage liver disease that used to die before they could receive a
liver transplant now can be supported and managed until they receive the definitive therapy of liver transplantation. Immunosuppressed patients behave differently than other critically ill patients. The delicate balance between over- and
underuse of immunosuppressant can lead to significant complications and negative consequences related to rejection, on one extreme, to multiple infections
and organ dysfunction on the other end.
The book is divided to two sections. Section 1 (Chapters 1–7) provides a
practical and detailed guide on how to manage patients when they present with
complications related to end-stage liver disease. Section 2 (Chapters 8–23)
addresses the peri-operative management of abdominal organ transplant
patients. It provides a very detailed and practical discussion regarding steps
taken in addressing the management of every possible complication that can be
encountered.
Since Dr Thomas Starzl’s arrival at the University of Pittsburgh and the start
of the transplant program here, the relationship between the transplant surgeons and the intensivists has continued to fl ourish so that intensivists have
become an integral part of a multidisciplinary team caring for these special
patients. Contributors to this book are authorities in their specialties who have
put their wealth of knowledge, clinical experience, and practice on paper. Some
of the recommendations in this book are not evidence-based for the simple
reason that evidence is lacking. I am very grateful to all of them for putting the
“Pittsburgh way” in writing to be shared with readers.
I hope this book will be a valuable practical reference for clinicians and students, junior or senior, in the specialties of critical care, gastroenterology, anesthesiology, and transplantation surgery.