title: Association between plasma cyclic guanosine monophosphate levels and hemodynamic instability during liver transplantation.
abstract: The activation of cyclic guanosine monophosphate (cGMP) production in patients with end-stage liver disease (ESLD) has been associated with hemodynamic instability during orthotopic liver transplantation (OLT). The aim of this prospective, observational study was to investigate the involvement of cGMP in the mediation of profound hypotension during liver graft reperfusion. An additional objective was to determine whether preoperative cGMP levels are associated with intraoperative hemodynamic instability. Forty-four consecutive patients undergoing OLT were included in the study. Blood samples for cGMP analysis were obtained from (1) the radial artery before the surgical incision; (2) the radial artery, portal vein, and flush blood during the anhepatic phase; and (3) the radial artery 20 minutes after liver graft reperfusion. On the basis of a statistical analysis, the patients were divided into 2 groups: group 1 (preoperative cGMP level ≥ 0.05 μmol/L) and group 2 (preoperative cGMP level < 0.05 μmol/L). We demonstrated a significant correlation between the preoperative levels of cGMP and the amount of catecholamine required to maintain hemodynamic stability during reperfusion (r = 0.52, P < 0.001), the length of the hospital stay (r = 0.38, P = 0.01), and the length of the intensive care unit (ICU) stay (r = 0.44, P = 0.004). We also demonstrated a significantly higher intraoperative catecholamine requirement (P < 0.001) and a prolonged postoperative ICU stay (P = 0.02) in group 1 patients versus group 2 patients. In conclusion, this study demonstrates increased baseline cGMP production in patients with ESLD, which is significantly associated with severe hypotension during OLT. We suggest that preoperative levels of cGMP correlate with hemodynamic instability during liver graft reperfusion.
authors.affiliation: Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, Hershey, PA 17033-0850, USA. dbezinover@hmc.psu.edu
authors.forename: Dmitri
authors.initials: D
authors.lastname: Bezinover
authors.forename: Zakiyah
authors.initials: Z
authors.lastname: Kadry
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Uemura
authors.forename: Michael
authors.initials: M
authors.lastname: Sharghi
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Mastro
authors.forename: Donna M
authors.initials: DM
authors.lastname: Sosnoski
authors.forename: Priti
authors.initials: P
authors.lastname: Dalal
authors.forename: Piotr K
authors.initials: PK
authors.lastname: Janicki
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002395:Catecholamines / Q000008:administration & dosage; D006152:Cyclic GMP / Q000097:blood*; D058625:End Stage Liver Disease / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D007362:Intensive Care Units; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D015854:Up-Regulation; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002395:Catecholamines; D014662:Vasoconstrictor Agents; D006152:Cyclic GMP