Reducing Pain With Methadone and Ketamine in Liver Transplant

Inclusion Criteria: * Adult patients ≥ 18 years of age at the time of LT. * Undergoing LT from a deceased donor. * Written informed consent obtained from subject or subject's legal representative and ability for subject to comply with the requirements of the study. Exclusion criteria: * Living donor liver transplantation (LDLT). * Split liver transplantation (isolated right or left lobe). * Acute liver failure (ALF) as the indication for LT. * Repeat (redo) liver transplant * Simultaneous liver and kidney transplant (SLK) * Sedation or high vasopressor use. * Subject is intubated and/or mechanically ventilated prior to entering the operating room for LT. * Severe Hepatic encephalopathy * History of psychiatric disorders such as schizophrenia or bipolar mood disorders * History of chronic opioid use, substance abuse or opioid maintenance therapies * Any history of allergic reaction to any of the study drugs History of Brugadda, prolonged QT syndrome or QTc in preoperative setting * Presence of a condition or abnormality that in the opinion of the Investigator would compromise the safety of the patient or the quality of the data * Prisoner * Pregnant person * Operational Exclusion Criterion: Subjects will not be enrolled if study personnel required for protocol execution (e.g., study investigator, research staff or pharmacy staff) are unavailable at the time of transplantation.