title: Optimal systemic hemodynamic stability for successful clinical outcomes after adult living-donor liver transplantation: prospective observational study.
abstract: 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.
authors.affiliation: Department of Hepato-pancreato-biliary Surgery and Transplantation, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan. horit@kuhp.kyoto-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; 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
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green