Liver transplantation is technically challenging due to the organ's size, complex anatomy, bleeding risks from portal hypertension, and the patient's compromised synthetic function (e.g., poor clotting factors) and debilitated state (cachexia, muscle loss).

“so so you've got the challenge of a large you know organ with challenging anatomy you have the challenge of this condition that makes the dissection and the predilection towards bleeding even higher and then you have the synthetic function which is occurs in the setting of a you're doing this operation in the setting of an individual who's not making normal normal clotting factors so it's really both the circumstance of the technical challenge but more more often the the um the circumstances in the in which you're doing it and you know as you know liver failure leads to cachexia and muscle loss so these are debilitated sick patients that you're then doing a big operation on in sub-optimal conditions”