Update in Liver Transplant Anesthesia.

Liver transplant anesthesia continues to undergo evolution. This review article explores 6 key domains. Combined heart‒liver transplantation is expanding, driven by Fontan-associated liver disease. Vasoplegia management options have been expanded by hydroxocobalamin and angiotensin II. Machine perfusion has transformed organ preservation, enabling real-time viability assessment and safe utilization of marginal and donation after circulatory death grafts. Viscoelastic hemostatic assays now guide transfusion management, though natural anticoagulant pathways remain undetectable by current platforms. Finally, planned intraoperative renal replacement therapy in carefully selected high-risk patients improves metabolic stability and perioperative outcomes.