Liver transplantation has evolved from an initial experimental procedure to a successful treatment for end-stage liver disease. This study explored milestones in liver transplantation anaesthetic care that contributed to improved outcomes in a single centre.

An analysis of transplant mortality outcomes was performed on adults and children who underwent liver transplantation between 1988 and 2019. A qualitative enquiry involved a thematic analysis of the opinions of retired and current anaesthetists.

Four overarching themes were identified:

Improved management of (a) intraoperative blood loss through the use of techniques such as preoperative coagulation screening, intraoperative blood salvage, and the use of blood transfusions (b) enhanced intraoperative monitoring through the use of techniques such as continuous echocardiography, transesophageal echocardiography, and pulmonary artery catheters and (c) the establishment of dedicated theatre space and staff for liver transplantation achieved through the construction of new dedicated liver transplantation units and the hiring of specialized staff were the key anaesthetic milestones that contributed to improved patient outcome following liver transplantation.