Direct measurement of hepatic blood flow in native and transplanted organs, with accompanying systemic hemodynamics.
The purpose of this study was to investigate intraoperatively a population of patients with end-stage liver disease before and after liver transplantation with respect to (a) the range of hepatic and systemic hemodynamics and their changes associated with transplantation and (b) the ability to identify native hemodynamic correlates with specific diagnostic groups. Hepatic artery and portal vein blood flows were determined with square-wave electromagnetic flowmetry. Significant differences related to the type of preservation solution used--Euro-Collins or University of Wisconsin--were identified in some hepatic and systemic hemodynamic measurements from the graft livers. Specifically, cardiac output, total liver blood flow and liver weight were significantly increased in the Euro-Collins group compared with the native and University of Wisconsin groups. Hepatic artery flow was significantly greater and portal vein pressure was significantly lower in the University of Wisconsin group than in the native or Euro-Collins group. In general, comparing the graft and native livers, hepatic artery and portal vein blood flow increased significantly after transplantation, as did hepatic oxygen consumption. Portal vein pressures were dramatically reduced, but systemic arterial pressure remained remarkably constant. The percentage of cardiac output going to the liver increased, as did the portal vein percentage of the total liver blood flow. Diagnostic groups could not clearly be associated with characteristic native liver or systemic hemodynamics. Hemodynamics may be associated more with the stage of the disease process than the disease itself.
Paulsen
A W
AW
Department of Anesthesiology, Baylor University Medical Center, Dallas, Texas 75246.
Klintmalm
G B
GB
D000328:Adult; D000704:Analysis of Variance; D001794:Blood Pressure; D002302:Cardiac Output; D006439:Hemodynamics; D006499:Hepatic Artery / Q000503:physiopathology; D006801:Humans; D008102:Liver Circulation; D016031:Liver Transplantation / Q000502:physiology*; D011168:Portal System / Q000503:physiopathology; D011169:Portal Vein / Q000503:physiopathology; D011336:Probability; D014655:Vascular Resistance