Prospective evaluation of intraoperative hemodynamics in liver transplantation with whole, partial and DCD grafts

M. Sainz-Barriga, K. Reyntjens, M. G. Costa, L. Scudeller, X. Rogiers, P. Wouters, B. De Hemptinne, R. I. Troisi

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)1850-1860
Number of pages11
JournalAmerican Journal of Transplantation
Volume10
Issue number8
DOIs
Publication statusPublished - Aug 2010

Keywords

  • DCD
  • graft inflow modulation
  • hepatic artery thrombosis
  • LDLT
  • liver flows
  • liver transplantation
  • portal hypertension
  • systemic and hepatic hemodynamics

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

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