title: Does Preoperative Beta-blocker Use Influence Intraoperative Hemodynamic Profile and Post-operative Course of Liver Transplantation?
abstract: OBJECTIVE
  We compared the intraoperative hemodynamic profiles and outcomes of liver transplant (LT) patients receiving preoperative beta-blockers for portal hypertension with those of patients not receiving beta-blockers.
  
  
  METHODS
  Beat-to-beat hemodynamic data were recorded with the use of a lithium dilution cardiac output monitor, including heart rate (HR), cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), SVR index, mean arterial pressure, stroke volume (SV), and SV index. Perioperative data included age, sex, etiology of cirrhosis, Model of End-Stage Liver Disease score, warm and cold ischemia times, and intraoperative blood and blood products replacement. Postoperative data included Acute Physiology and Chronic Health Evaluation II score, Intensive Care National Audit and Research Centre (ICNARC) score, length of intensive care unit stay, renal replacement treatment, and mortality.
  
  
  RESULTS
  After exclusion, 215 patients not receiving and 93 patients receiving beta-blockers for portal hypertension were included. There was no significant difference between groups in demographic data. HR, CO, and CI were significantly lower in the beta-blocker group (P = .0001). Regarding outcomes, the ICNARC score was significantly higher in the beta-blocker group (P < .05).
  
  
  CONCLUSIONS
  Preoperative administration of beta-blockers attenuates the hyperdynamic circulation in LT patients; this is clearly seen through a reduction in intraoperative CO, CI, and HR. This decreased hyperdynamic state was not shown to relate to outcomes in any of the variables except for a higher ICNARC score reported in the group treated with beta-blockers.
authors.affiliation: Leeds Teaching Hospital, Leeds, United Kingdom; now at King's College Hospital, London, United Kingdom. Electronic address: zoka.milan@kcl.ac.uk.
authors.forename: Z
authors.initials: Z
authors.lastname: Milan
authors.affiliation: School of Mathematics, University of Leeds, Leeds, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Taylor
authors.affiliation: Leeds Teaching Hospital, Leeds, United Kingdom; now at: Scarborough General Hospital, Scarborough, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Armstrong
authors.affiliation: Leeds Teaching Hospital, Leeds, United Kingdom; now at: Gartnaval General Hospital, Glasgow, Scotland, United Kingdom.
authors.forename: P
authors.initials: P
authors.lastname: Davies
authors.affiliation: Leeds Teaching Hospital, Leeds, United Kingdom; now at: University Hospital of South Manchester, Wythenshawe, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Roberts
authors.affiliation: Maribor University Hospital, Maribor, Slovenia.
authors.forename: B
authors.initials: B
authors.lastname: Rupnik
authors.affiliation: King's College Hospital, Denmark Hill, London, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Suddle
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000328:Adult; D062186:Arterial Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D016022:Case-Control Studies; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007432:Intraoperative Period; D008103:Liver Cirrhosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists