title: Positive end-expiratory pressure induces liver congestion in living donor liver transplant patients: myth or fact.
abstract: Living-donated liver transplant (LDLT) patients may develop lung edema during reperfusion, requiring higher positive end-expiratory pressure (PEEP) levels, which may impair liver outflow. The aim of the study was to assess the effect of increased PEEP levels on venous liver outflow and systemic hemodynamics in patients after LDLT. Thirty-nine LDLT recipients were enrolled in this study. All patients were postoperatively pressure-controlled ventilated and three different PEEP levels (0, 5 and 10 mbar) were randomly set. Systemic hemodynamic parameters and flow velocities of the hepatic artery, portal vein, and right hepatic vein were recorded at each PEEP level. PEEP of 10 mbar increased significantly central venous and pulmonary capillary pressure. Flow velocities in the right hepatic vein, the portal vein, the hepatic artery, mean arterial pressure, pulmonary arterial pressure, and cardiac index were not influenced by PEEP. Our study demonstrated that PEEP up to 10 mbar did not impair liver outflow in LDLT recipients.
authors.affiliation: Department of General-, Visceral- and Transplant Surgery, University Hospital Essen, Essen, Germany. fuat.saner@uni-due.de
authors.forename: Fuat H
authors.initials: FH
authors.lastname: Saner
authors.forename: Steven W M
authors.initials: SW
authors.lastname: Olde Damink
authors.forename: Goran
authors.initials: G
authors.lastname: Pavlaković
authors.forename: Maartje A J
authors.initials: MA
authors.lastname: van den Broek
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Arnold
authors.initials: A
authors.lastname: Radtke
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006499:Hepatic Artery / Q000502:physiology; D006503:Hepatic Veins / Q000502:physiology; D006801:Humans; D008099:Liver / Q000098:blood supply*; D016031:Liver Transplantation / Q000502:physiology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000502:physiology; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D012039:Regional Blood Flow / Q000502:physiology