Hemodynamic profile and tissular oxygenation in orthotopic liver transplantation: Influence of hepatic artery or portal vein revascularization of the graft.
We performed a prospective, randomized study of adult patients undergoing orthotopic liver transplantation, comparing hemodynamic and tissular oxygenation during reperfusion of the graft. In 30 patients, revascularization was started through the hepatic artery (i.e., initial arterial revascularization) and 10 minutes later the portal vein was unclamped; in 30 others, revascularization was started through the portal vein (i.e., initial portal revascularization) and 10 minutes later the hepatic artery was unclamped. The primary endpoints of the study were mean systemic arterial pressure and the gastric-end-tidal carbon dioxide partial pressure (PCO(2)) difference. The secondary endpoints were other hemodynamic and metabolic data. The pattern of the hemodynamic parameters and tissue oxygenation values during the dissection and anhepatic stages were similar in both groups At the first unclamping, initial portal revascularization produced higher values of mean pulmonary pressure (25 +/- 7 mm of Hg vs. 17 +/- 4 mm of Hg; P < 0.05) and wedge and central venous pressures. At the second unclamping, initial portal revascularization produced higher values of cardiac output and mean arterial pressure (87 +/- 15 mm of Hg vs. 79 +/- 15 mm of Hg; P < 0.05) and pulmonary blood pressure. Postreperfusion syndrome was present in 13 patients (42.5%) in the arterial group and in 11 patients (36%) in the portal group. During revascularization, the values of gastric and arterial pH decreased in both groups and recovered at the end of the procedure, but were more accentuated in the initial arterial revascularization group. In conclusion, we found that initial arterial revascularization of the graft increases pulmonary pressure less markedly, so it may be indicated for those patients with poor pulmonary and cardiac reserve. Nevertheless, for the remaining patients, initial portal revascularization offers more favorable hemodynamic and metabolic behavior, less inotropic drug use, and earlier normalization of lactate and pH values.
Moreno
Carlos
C
Department of Anesthesiology, University Hospital of Bellvitge, Barcelona, Spain.
Sabaté
Antoni
A
Figueras
Joan
J
Camprubí
Imma
I
Dalmau
Antonia
A
Fabregat
Joan
J
Koo
Maylin
M
Ramos
Emilio
E
Lladó
Laura
L
Rafecas
Antoni
A
D000136:Acid-Base Equilibrium; D000328:Adult; D000368:Aged; D001158:Arteries; D001769:Blood / Q000378:metabolism; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000378:metabolism; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016031:Liver Transplantation / Q000379:methods*; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010313:Partial Pressure; D011169:Portal Vein / Q000601:surgery*; D011312:Pressure; D013990:Tidal Volume; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D002245:Carbon Dioxide