title: Stability of cirrhotic systemic hemodynamics ensures sufficient splanchnic blood flow after living-donor liver transplantation in adult recipients with liver cirrhosis.
abstract: OBJECTIVE
  To investigate the correlation between systemic hemodynamics and splanchnic circulation in recipients with cirrhosis undergoing living-donor liver transplantation (LDLT), and to clarify how systemic hemodynamics impact on local graft circulation after LDLT.
  
  
  METHODS
  Systemic hemodynamics, indocyanine green (ICG) elimination rate (K ICG) and splanchnic circulation were simultaneously and non-invasively investigated by pulse dye densitometry (PDD) and ultrasound. Accurate estimators of optimal systemic hyperdynamics after LDLT [i.e., balance of cardiac output (CO) to blood volume (BV) and mean transit time (MTT), defined as the time required for half the administered ICG to pass through an attached PDD sensor in the first circulation] were also measured. Thirty recipients with cirrhosis were divided into two groups based on clinical outcomes corresponding to postoperative graft function.
  
  
  RESULTS
  Cirrhotic systemic hyperdynamics characterized by high CO, expanded BV and low total peripheral resistance (TPR) were observed before LDLT. TPR reflecting cirrhotic vascular alterations was slowly restored after LDLT in both groups. Although no significant temporal differences in TPR were detected between the two groups, CO/BV and MTT differed significantly. Recipients with good outcomes showed persistent cirrhotic systemic hyperdynamics after LDLT, whereas recipients with poor outcomes presented with unstable cirrhotic systemic hyperdynamics and severely decreased K ICG. Systemic hyperdynamic disorders after LDLT impacted on portal venous flow but not hepatic arterial flow.
  
  
  CONCLUSIONS
  We conclude that subtle systemic hyperdynamics disorders impact on splanchnic circulation, and that an imbalance between CO and BV decreases portal venous flow, which results in critical outcomes.
authors.affiliation: Department of Hepatobiliary Pancreatic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan. tomohide@clin.medic.mie-u.ac.jp
authors.forename: Tomohide
authors.initials: T
authors.lastname: Hori
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yagi
authors.forename: Taku
authors.initials: T
authors.lastname: Iida
authors.forename: Kentaro
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamagiwa
authors.forename: Chiduru
authors.initials: C
authors.lastname: Yamamoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yamakado
authors.forename: Takuma
authors.initials: T
authors.lastname: Kato
authors.forename: Kanako
authors.initials: K
authors.lastname: Saito
authors.forename: Linan
authors.initials: L
authors.lastname: Wang
authors.forename: Mie
authors.initials: M
authors.lastname: Torii
authors.forename: Yukinobu
authors.initials: Y
authors.lastname: Hori
authors.forename: Kan
authors.initials: K
authors.lastname: Takeda
authors.forename: Kazuo
authors.initials: K
authors.lastname: Maruyama
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
mesh_terms: D000328:Adult; D001810:Blood Volume / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D005260:Female; D006499:Hepatic Artery / Q000502:physiology; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000502:physiology; D011877:Radionuclide Imaging; D012039:Regional Blood Flow / Q000502:physiology; D013152:Splanchnic Circulation / Q000502:physiology*; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler