TY - JOUR
T1 - Prospective evaluation of intraoperative hemodynamics in liver transplantation with whole, partial and DCD grafts
AU - Sainz-Barriga, M.
AU - Reyntjens, K.
AU - Costa, M. G.
AU - Scudeller, L.
AU - Rogiers, X.
AU - Wouters, P.
AU - De Hemptinne, B.
AU - Troisi, R. I.
PY - 2010/8
Y1 - 2010/8
N2 - 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. 2010 The American Society of Transplantation and the American Society of Transplant Surgeons.
AB - 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. 2010 The American Society of Transplantation and the American Society of Transplant Surgeons.
KW - DCD
KW - graft inflow modulation
KW - hepatic artery thrombosis
KW - LDLT
KW - liver flows
KW - liver transplantation
KW - portal hypertension
KW - systemic and hepatic hemodynamics
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U2 - 10.1111/j.1600-6143.2010.03207.x
DO - 10.1111/j.1600-6143.2010.03207.x
M3 - Article
C2 - 20659091
AN - SCOPUS:77954891908
VL - 10
SP - 1850
EP - 1860
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 8
ER -