Prospective Evaluation of Intraoperative Hemodynamics in Liver Transplantation with Whole, Partial and DCD Grafts

• Published in: American journal of transplantation Vol. 10; no. 8; pp. 1850 - 1860
• Main Authors: Sainz‐Barriga, M., Reyntjens, K., Costa, M. G., Scudeller, L., Rogiers, X., Wouters, P., De Hemptinne, B., Troisi, R. I.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.08.2010; Wiley
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Blood Flow Velocity; DCD; Death; Female; graft inflow modulation; Hemodynamics - physiology; Hepatic Artery - physiology; hepatic artery thrombosis; Humans; Intraoperative Period; LDLT; Liver Circulation - physiology; liver flows; liver transplantation; Liver Transplantation - methods; Liver, biliary tract, pancreas, portal circulation, spleen; Living Donors; Male; Medical sciences; Middle Aged; portal hypertension; Portal Vein - physiology; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; systemic and hepatic hemodynamics; Evaluation; graft inflow modulation; LDLT; portal hypertension; DCD; Digestive system; liver flows; Liver; Intraoperative; Homotransplantation; Prospective; Treatment; hepatic artery thrombosis; Partial; systemic and hepatic hemodynamics; Surgery; Graft; Hemodynamics; Liver transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2010.03207.x

The interaction of systemic hemodynamics with hepatic flows at the time of liver transplantation (LT) has not been studied in a prospective uniform way for different types of grafts. We prospectively evaluated intraoperative hemodynamics of 103 whole and partial LT. Liver graft hemodynamics were measured using the ultrasound transit time method to obtain portal (PVF) and arterial (HAF) hepatic flow. Measurements were recorded on the native liver, the portocaval shunt, following reperfusion and after biliary anastomosis. After LT HAF and PVF do not immediately return to normal values. Increased PVF was observed after graft implantation. Living donor LT showed the highest compliance to portal hyperperfusion. The amount of liver perfusion seemed to be related to the quality of the graft. A positive correlation for HAF, PVF and total hepatic blood flow with cardiac output was found (p = 0.001). Portal hypertension, macrosteatosis >30%, warm ischemia time and cardiac output, independently influence the hepatic flows. These results highlight the role of systemic hemodynamic management in LT to optimize hepatic perfusion, particularly in LDLT and split LT, where the highest flows were registered. Hepatic graft inflow and perfusion varied according to the type and quality of the organ, and according to systemic hemodynamics and cardiac output.