title: Hyperdynamic circulation in cirrhosis: predictive factors and outcome following liver transplantation.
abstract: BACKGROUND
  Liver cirrhosis is associated with a hyperdynamic circulation (HC). In this observational study, we aimed to investigate the predictive factors of HC, its impact on intraoperative hemodynamic and postoperative outcome, early ICU and in-hospital mortality, in cirrhotic patients undergoing orthotopic liver transplantation (OLT).
  
  
  METHODS
  Two hundred and forty-two patients with cirrhosis undergoing cadaveric OLT were included. Before starting the transplant procedure and under general anesthesia, a pulmonary artery catheter was introduced to assess hemodynamic parameters. The baseline assessment was carried out approximately 30 minutes after the catheter placement and repeated during the anhepatic phase, 10 minutes after the reperfusion and at the end of surgery. The patients were divided into two groups: in group 1 the patients had SVR>900dynes s-1 m-2 cm-5, in group 2 SVR ≤900 dynes s-1 m-2 cm-5.
  
  
  RESULTS
  Eighty-two patients (33%) presented severe HC. In multivariate analysis 2 factors were associated with the occurrence of HC: beta-blockers use (Exp [B]=4.42 (95% CI 1.18-17); P=0.001, [34% and 12% in groups 1 and 2, P<0.001, respectively]) and model for end-stage liver disease (MELD) score (Exp [B]=1.066; 95% CI=1.025-1.109; P=0.001).
  
  
  CONCLUSIONS
  MELD score was an independent predictor of HC, and beta-blockers resulted associated with lower incidence of HC in cirrhotic patients undergoing cadaveric OLT. Intraoperative HC correlates with hemodynamic alterations, requiring more blood products and vasopressor use, this may increase the risk of renal failure, early ICU death and in-hospital mortality.
authors.affiliation: Department of Anesthesiology, Alma Mater Studiorum-University of Bologna, Bologna, Italy. sinianest@libero.it
authors.forename: A
authors.initials: A
authors.lastname: Siniscalchi
authors.forename: L
authors.initials: L
authors.lastname: Aurini
authors.forename: S
authors.initials: S
authors.lastname: Spedicato
authors.forename: E
authors.initials: E
authors.lastname: Bernardi
authors.forename: A
authors.initials: A
authors.lastname: Zanoni
authors.forename: A
authors.initials: A
authors.lastname: Dante
authors.forename: M
authors.initials: M
authors.lastname: Cimatti
authors.forename: L
authors.initials: L
authors.lastname: Gamberini
authors.forename: S
authors.initials: S
authors.lastname: Faenza
mesh_terms: D000328:Adult; D000758:Anesthesia; D005260:Female; D005544:Forecasting; D006801:Humans; D007432:Intraoperative Period; D008102:Liver Circulation / Q000502:physiology*; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome