[Hemodynamics of the cirrhotic patient during liver transplantation. Influence of the preservation of portal and vena cava flow].
OBJECTIVE
To describe the hemodynamic pattern of patients undergoing liver transplantation with preservation of portocaval flow.


METHODS
A prospective study of 20 cirrhotic patients who had not previously undergone surgery for portal hypertension or had porto-systemic bypass, both of which have hemodynamic effects in the cirrhotic patient. The patients were transplanted with preservation of inferior vena cava flow and temporary portocaval shunt.


RESULTS
The decrease in cardiac output during the anhepatic phase was only 10% and mean blood pressure (77.6 +/- 11 versus 76 +/- 10 mm Hg) and supply pressures (central venous pressure 9.1 +/- 5.5 versus 8.4 +/- 5.3 mm Hg; pulmonary capillary pressure 11.4 +/- 6.1 versus 11.3 +/- 7.4 mm Hg) remained stable. Likewise, no significant increase in systemic vascular resistance (614 +/- 223 versus 676 +/- 306 dyne-sec/cm5) or heart rate (90 +/- 14 versus 97 +/- 17 beats/min). The number of units of packed red cells was 2.7 +/- 2.5 and 35% of the patients required no transfusions. Diuresis was stable throughout the procedure (total diuresis 3.6 +/- 2.4 mL/Kg/h; anhepatic phase 1.3 +/- 1.5 mL/Kg/h).


CONCLUSIONS
Creation of a portocaval shunt during the anhepatic phase of liver transplantation allows hemodynamic vital signs to be held stable, decreases the need for transfusion and maintains diuresis.
Lladó
L
L
Servicio de Cirugía General y Digestiva  Ciutat Sanitaria i Universitaria de Bellvitge, Barcelona.
Lama
C
C
Busquets
J
J
Ibáñez
L
L
Dalmau
A
A
Camprubí
I
I
Sanzol
R
R
Jaurrieta
E
E
D005260:Female; D006439:Hemodynamics; D006801:Humans; D007432:Intraoperative Period; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000503:physiopathology*; D011446:Prospective Studies; D014682:Vena Cava, Inferior / Q000503:physiopathology*