Factors affecting metabolic and electrolyte changes after reperfusion in liver transplantation.
BACKGROUND
The metabolic and electrolyte changes were evaluated after various durations of cold and warm ischemia times to correlate ASA status with hemodynamic changes that may affect the severity of the reperfusion syndrome.


METHODS
Sixty-one patients who underwent liver transplantation (OLT) were monitored by arterial pH, PaO2, PaCO2, HCO2, BE, K+, Ca2+, Na+, GL, and serial Ht at three specific times: after the skin incision (baseline), 10 minutes before reperfusion (T2), and 10 minutes after reperfusion (T3). Changes in metabolic parameters were correlated with ASA status, hemodynamic changes, time of OLT, as well as cold and warm ischemia times.


RESULTS
The pH in ASA IV patients was significantly lower at T1 and T3, and PCO2 higher in ASA V at T1. A significant correlation was observed between pH, PaCO2, HCO3-, BE, Na+, Ca2+, and glucose with the phase of the procedure. The pH and HCO3- decreased significantly from T1 and T2, increasing during T3. Ca2+ fell from T1 to T2 increasing in T3. Mean glucose and sodium levels increase from T1 to T3. Mean BE dropped from T1 to T2 and increased at T3 without a significant correlation between the metabolic parameters in any phase of the study and the cold or warm ischemia times. Patients with a high ASA status showed an increased risk for cardiovascular collapse after reperfusion.


CONCLUSIONS
Patients with advanced ASA status are more prone to metabolic and acid-base disturbances during reperfusion, without any relation to the cold or warm ischemia times. High ASA status shows an increased risk for cardiovascular collapse after reperfusion.
Tsinari
K K
KK
Department of Anestestiology, University of Miami, School of Medicine, FL, USA.
Misiakos
E P
EP
Lawand
C T
CT
Chatzipetrou
M A
MA
Lampadariou
K V
KV
Bakonyi Neto
A
A
Llanos
J C
JC
Tamura
S
S
Gyamfi
A R
AR
Tzakis
A G
AG
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood; D015331:Cohort Studies; D004573:Electrolytes / Q000097:blood*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016031:Liver Transplantation / Q000379:methods / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D015424:Reperfusion / Q000379:methods*
D004573:Electrolytes; D002245:Carbon Dioxide; D010100:Oxygen