Vasopressor agents without volume expansion as a safe alternative to venovenous bypass during cavaplasty liver transplantation.
BACKGROUND
Cavaplasty orthotopic liver transplantation (OLT) offers advantages for hepatectomy and implantation and eliminates the risk of outflow obstruction. However, it does require clamping of the cava. This study describes the use of a vasopressor without fluid expansion or venovenous bypass (VB) for hemodynamic control during the anhepatic phase.


METHODS
The cavaplasty OLT technique was used routinely. A vasopressor was administered if the mean arterial blood pressure (MAP) was less than 60 mm Hg after clamping of the cava. If the MAP did not reach 60 mm Hg after adjusting the dosage of the vasopressor, femoro-axillary VB would be used. VB was also indicated for preexisting cardiac disease or for massive hemorrhage from severe portal hypertension and extensive adhesions.


RESULTS
Among all the 121 adult cavaplasty OLTs, 33 were supported with VB and 50 received a vasopressor. The remaining 38 were excluded. However, baseline variables were well matched, except that preexisting cardiac disease was more frequent in the VB group. The median dosage of epinephrine was 0.07 microg/kg/min (range 0.01-0.6). The VB and vasopressor groups were similar in the reduction in mean MAP and the accumulation in arterial lactate upon clamping as well as in the central venous pressure upon unclamping. Postreperfusion hypotension was more frequent in the VB than in the vasopressor group (27.3% vs. 4.0%, P=0.006). There was no primary graft nonfunction or intraoperative right heart failure. One patient in the vasopressor group required postoperative temporary dialysis. Ninety-day patient and graft survival for the VB and vasopressor groups were 97.0% vs. 98.0% and 97.0% vs. 94.0%, respectively.


CONCLUSIONS
Modest doses of vasopressor without volume expansion or VB can maintain hemodynamic stability during the anhepatic phase of cavaplasty OLT.
Wu
Youmin
Y
Department of Surgery, 1521 JCP, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA. you-wu@uiowa.edu
Oyos
Tanya L
TL
Chenhsu
Rou-Yee
RY
Katz
Daniel A
DA
Brian
Johnny E
JE
Rayhill
Stephen C
SC
D000328:Adult; D004231:Diuresis; D004911:Erythrocyte Volume; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007430:Intraoperative Care; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008824:Michigan; D016343:Monitoring, Intraoperative / Q000379:methods; D010976:Platelet Count; D011167:Portacaval Shunt, Surgical / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents