Intraoperative fluid management during orthotopic liver transplantation.
OBJECTIVE
To assess clinical safety of a low central venous pressure (CVP) fluid management strategy in patients undergoing liver transplantation.


METHODS
Retrospective record review comparing 2 transplant centers, one using the low CVP method and the other using the normal CVP method.


METHODS
University-based, academic, tertiary care centers.


METHODS
Patients undergoing orthotopic cadaveric liver transplantation.


METHODS
Each center practiced according to its own standard of care. Center 1 maintained an intraoperative CVP <5 mmHg using fluid restriction, nitroglycerin, forced diuresis, and morphine. If pressors were required to maintain systolic arterial pressure >90 mmHg, phenylephrine or norepinephrine was used. At center 2, CVP was kept 7 to 10 mmHg and mean arterial pressure >75 mmHg with minimal use of vasoactive drugs.


RESULTS
Data collected included United Network for Organ Sharing status, surgical technique, intraoperative transfusion rate, preoperative and peak postoperative creatinine, time spent in intensive care unit and hospital, incidence of death, and postoperative need for hemodialysis. Principal findings include an increased rate of transfusion in the normal CVP group but increased rates of postoperative renal failure (elevated creatinine and more frequent need for dialysis) and 30-day mortality in the low CVP group.


CONCLUSIONS
Despite success in lowering blood transfusion requirements in liver resection patients, a low CVP should be avoided in patients undergoing liver transplantation.
Schroeder
Rebecca A
RA
Department of Anesthesiology, Duke University School of Medicine, Durham, NC 27705, USA. Schro016@mc.duke.edu
Collins
Bradley H
BH
Tuttle-Newhall
Elizabeth
E
Robertson
Kerri
K
Plotkin
Jeffrey
J
Johnson
Lynt B
LB
Kuo
Paul C
PC
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001794:Blood Pressure / Q000187:drug effects; D001803:Blood Transfusion; D002496:Central Venous Pressure; D003404:Creatinine / Q000097:blood; D004231:Diuresis; D005260:Female; D006801:Humans; D020896:Hypovolemia; D007430:Intraoperative Care; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009020:Morphine / Q000627:therapeutic use; D005996:Nitroglycerin / Q000627:therapeutic use; D011183:Postoperative Complications; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
D000316:Adrenergic alpha-Agonists; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D009020:Morphine; D003404:Creatinine; D005996:Nitroglycerin