Optimal systemic hemodynamic stability for successful clinical outcomes after adult living-donor liver transplantation: prospective observational study.
OBJECTIVE
Most living-donor liver transplantation (LDLT) recipients show characteristic systemic hemodynamics due to liver cirrhosis, and systemic hemodynamics after LDLT influenced postoperative graft function corresponding to outcomes. However, identities of optimal systemic hemodynamics for excellent outcomes and precise parameters for clinical strategy remain unclear.


METHODS
Therefore, we performed prospective study in adult LDLT recipients from 2003. Hemodynamic parameters were prospectively recorded, and were analyzed in 40 recipients classified into three groups: cirrhotic (group I-C) or non-cirrhotic recipients (group I-NC) with good outcomes, and cirrhotic recipients (group II-C) without good outcomes.


RESULTS
Group I-C retained characteristic hyperdynamics even after LDLT. However, absolute values of parameters revealed no significant differences between groups I-C and II-C, because group II-C also tended to show hyperdynamics. It is suggested that successful outcomes in cirrhotic recipients require maintenance of optimal hyperdynamic stability after LDLT, because cirrhotic vascular alterations still occurred. Because hemodynamic behaviors were different between groups I-C and I-NC, absolute values were also significantly different even in these successful two groups. Thus, absolute values themselves were not necessarily satisfactory for accurate evaluation of optimal hemodynamic stability. Cirrhotic hyperdynamics are symbolized in large blood volume (BV) circulated by high cardiac output (CO); therefore, we standardized CO against BV. CO/BV was significantly different between groups I-C and II-C, reflecting subtle variability of hyperdynamics in groups II-C, and was interestingly constant in the two successful groups. Therefore, CO/BV reliably evaluated optimal hemodynamic stability after LDLT, and accurately predicted outcomes.


CONCLUSIONS
Identification of inappropriate hemodynamics after LDLT is advantageous to further improve LDLT outcomes.
Hori
Tomohide
T
Department of Hepato-pancreato-biliary Surgery and Transplantation, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan. horit@kuhp.kyoto-u.ac.jp
Yagi
Shintaro
S
Iida
Taku
T
Taniguchi
Kentaro
K
Yamagiwa
Kentaro
K
Yamamoto
Chiduru
C
Hasegawa
Takashi
T
Yamakado
Koichiro
K
Kato
Takuma
T
Saito
Kanako
K
Wang
Linan
L
Torii
Mie
M
Hori
Yukinobu
Y
Takeda
Kan
K
Maruyama
Kazuo
K
Uemoto
Shinji
S
D000328:Adult; D001794:Blood Pressure; D001810:Blood Volume; D002302:Cardiac Output; D004396:Coloring Agents; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007208:Indocyanine Green; D008103:Liver Cirrhosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D019520:Living Donors; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014655:Vascular Resistance
D004396:Coloring Agents; D007208:Indocyanine Green