Hemodynamic changes during reperfusion of the graft in an animal model of liver xenotransplantation.
Our goal was to determine the hemodynamic changes that are witnessed during the initial minutes of reperfusion of the graft in liver xenotransplantation from pig to baboon.


METHODS
We studied a group of 12 baboons undergoing transplantation of a pig liver via the classic technique with arterial anastomosis to the aorta. The anesthesia technique was similar to that used in humans. Hemodynamic monitoring, due to the size of the recipient, consisted of heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP) recorded at the beginning and end of each of the three phases: preanhepatic (A1, A2), anhepatic (B1, B2), and neohepatic (C1 and C2). We aimed to maintain the following values by means of crystalloids, colloids, and blood derivates: HR >50 beats/minute; MAP >60 mm Hg; and CVP >10 mm Hg.


RESULTS
Both HR and CVP remained unchanged throughout the procedure. MAP droped briefly after vascular clamping (B1) but not on reperfusion (C1).


CONCLUSIONS
In cirrhotic patients there is an autonomic dysfunction, demonstrated as cardiovascular instability at times like the clamping of major vessels and reperfusion of the graft. On the other hand, the intact baboon has an intact nervous system. After vascular clamping, the sharp decrease in venous return lead to an adequate vasopressor response. Likewise, the extreme vasodilatation involved with reperfusion managed to maintain MAP above 70 mm Hg.
Palenciano
C G
CG
Liver Transplant Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain.
Acosta
F
F
Segura
B
B
Sansano
T
T
Ramírez
P
P
Fernandez-Rodriguez
O
O
Majado
M
M
Ríos
A
A
Munoz
A
A
Robles
R
R
Bueno
F S
FS
Parrilla
P
P
D000714:Anastomosis, Surgical; D000818:Animals; D001011:Aorta / Q000601:surgery; D001794:Blood Pressure / Q000502:physiology*; D002097:C-Reactive Protein / Q000032:analysis; D006339:Heart Rate / Q000502:physiology*; D016031:Liver Transplantation / Q000502:physiology*; D023421:Models, Animal; D016343:Monitoring, Intraoperative; D010215:Papio; D013552:Swine; D014183:Transplantation, Heterologous / Q000502:physiology*
D002097:C-Reactive Protein