Liver transplantation Surgical aspects and evolution of the technique: A literature review

Abstract

Introduction: Liver transplantation is a complex procedure indicated for patients with acute or chronic liver failure, whose success depends on appropriate donor and recipient selection, technical advancements, and multidisciplinary management. Objective: This study conducted a literature review on the surgical aspects and technical evolution of liver transplantation, emphasizing perioperative and postoperative care, complications, institutional protocols, impacts on patient survival and quality of life, and the importance of physiotherapy in functional rehabilitation and prevention of postoperative complications. Methods: A descriptive and analytical literature review was conducted, based on national and international publications available in the Virtual Health Library (BVS), PubMed (Public/Publisher MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS), and the Virtual Health Library (BVS). Studies published between 2017 and 2025, in Portuguese, English, and Spanish, were included, encompassing reviews, descriptive studies, interventional studies, and institutional guidelines. Duplicate articles, isolated opinions, and interviews were excluded. Study selection was performed in three stages: identification, screening of titles and abstracts, and full-text reading of eligible studies. Results: Findings indicate that advanced surgical techniques, institutional protocols, intensive monitoring, and multidisciplinary care are crucial for graft preservation, morbidity reduction, and improved quality of life. Studies highlight the importance of standardized practices, waitlist management, infection prevention, and patient education to optimize clinical outcomes, as well as early physiotherapy intervention, including respiratory exercises, early mobilization, and functional training, which help reduce postoperative complications. Challenges include regional disparities in access, prolonged waiting times, and structural gaps in healthcare services. Conclusion: The success of liver transplantation depends on the integration of technical evolution, evidence-based protocols, multidisciplinary care, and continuous monitoring. Structured and individualized strategies, combined with patient education, implementation of postoperative physiotherapy protocols, and optimization of institutional resources, are essential to improve clinical outcomes, graft survival, and quality of life.