Transesophageal echocardiography during orthotopic liver transplantation in patients with esophagoastric varices.
BACKGROUND
Hemodynamic monitoring using transesophageal echocardiography (TEE) in patients with signs of portal hypertension undergoing orthotopic liver transplantation (OLT) carries potential risk of esophageal and gastric variceal hemorrhage. The aim of our retrospective analysis was to evaluate the safety of intraoperative TEE monitoring during OLT in patients with esophagogastric varices.


METHODS
A retrospective analysis of 396 liver transplant recipients was performed at the Medical University of Vienna monitored by TEE during OLT between 2003 and 2010.


RESULTS
Varices were documented by esophagogastroduodenoscopy in 287 (72.5%) of 396 analyzed patients: 130 (32.8%) varices grade I (<5 mm under insufflation) and 157 (39.6%) varices grade II (>5 mm under insufflation). Red spot signs were identified in 40 patients (10.1%). Most varices (82.2%) were documented in the esophagus, 4.2% in the stomach, and 13.6% in both (esophagus and stomach). Only one major bleeding occurred, and it was only in a case of one patient with an esophageal varix, which was treated with a balloon tamponade during OLT. Although patients with varices demonstrated a significantly longer prothrombin time and lower platelet count, there was no significant difference in the requirement for blood products among patients with and without varices.


CONCLUSIONS
TEE is a relatively safe method for monitoring cardiac performance with a low incidence of major hemorrhagic complications in patients with documented esophagogastric varices undergoing OLT.
Department of Anesthesiology and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria.
Ursula
U
Burger-Klepp
Rastko
R
Karatosic
Maximillian
M
Thum
Remy
R
Schwarzer
Valentin
V
Fuhrmann
Hubert
H
Hetz
Andreas
A
Bacher
Gabriela
G
Berlakovich
Claus G
CG
Krenn
Peter
P
Faybik
D017548:Echocardiography, Transesophageal / Q000009:adverse effects; D058625:End Stage Liver Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012189:Retrospective Studies