title: Autonomic neuropathy is associated with hemodynamic instability during human liver transplantation.
abstract: BACKGROUND
  End-stage liver disease is frequently associated with autonomic neuropathy (AN). The hemodynamic changes during liver transplantation (LT) require an adequate autonomic response to maintain cardiovascular stability.
  
  
  METHODS
  Forty-one patients undergoing LT were evaluated for the influence of AN on the evolution after LT. AN was previously evaluated by seven cardiovascular tests assessing sympathetic (Sy) or parasympathetic (P) function. Patients were classified as absent (A), early (E), or definite dysfunction (D). A hemodynamic study was performed before and after vascular clampings. The analysis included the duration of LT, transfusion requirements, intra-operative artenal hypotensive episodes, incidence of postreperfusion syndrome (PRS), cardiac arrhythmias and vasoactive drug requirements.
  
  
  RESULTS
  The hyperdynamic circulation worsened during surgery in D patients, as shown by a significantly increased cardiac output and a significantly decreased systemic vascular resistance. The incidence of PRS was greater in the AN group. Arterial hypotension during the neohepatic period was more frequent among patients with AN, more frequently requiring vasoconstrictor and inotropic therapy.
  
  
  CONCLUSIONS
  AN is associated with hemodynamic impairment and with increased vasoactive drug requirements during liver transplantation, probably associated with impaired reflex vasoconstrictor responses to surgical manipulations and changes of blood volume. AN may be associated with a greater surgical risk during LT. Preoperative evaluation of AN may select a high-risk population of LT recipients.
authors.affiliation: Anesthesiology Department, University Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Pérez-Peña
authors.forename: D
authors.initials: D
authors.lastname: Rincón
authors.forename: R
authors.initials: R
authors.lastname: Bañares
authors.forename: L
authors.initials: L
authors.lastname: Olmedilla
authors.forename: I
authors.initials: I
authors.lastname: Garutti
authors.forename: D
authors.initials: D
authors.lastname: Arnal
authors.forename: J
authors.initials: J
authors.lastname: Calleja
authors.forename: G
authors.initials: G
authors.lastname: Clemente
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001342:Autonomic Nervous System Diseases / Q000503:physiopathology*; D016009:Chi-Square Distribution; D005260:Female; D006439:Hemodynamics; D006509:Hepatitis B / Q000503:physiopathology / Q000601:surgery; D006526:Hepatitis C / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000503:physiopathology / Q000601:surgery*; D017093:Liver Failure / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged