High Flow-Mediated Vasodilatation Predicts Pulmonary Edema in Liver Transplant Patients.
BACKGROUND
Early pulmonary edema is common after orthotopic liver transplantation. Associated pathogenic mechanisms might involve increased activity of cardiac-inhibitory systems due to increased vasodilator production, mainly nitric oxide (NO). NO is primarily responsible for flow-mediated vasodilatation (FMD). We investigated the incidence of pulmonary edema in liver transplant patients and its correlation with FMD.


METHODS
We prospectively evaluated traditional risk factors, Doppler echocardiographic findings, derived hemodynamic data, and brachial artery nitroglycerin-induced vasodilatation (NTD) and FMD within 1 week prior to liver transplantation in 54 consecutive liver transplant patients with cirrhosis. Post-transplantation chest roentgenography was performed daily. In-hospital outcomes, transfusion volume of blood components, and hemodynamic data during surgery and at the intensive care unit were analyzed.


RESULTS
Twenty-nine patients (53.7%) developed radiological pulmonary edema within 1 week of transplantation. Diffuse-type interstitial and alveolar pulmonary edema constituted 13 cases (24.1%). Patients with pulmonary edema had higher pretransplantation Child-Turcotte-Pugh scores (p = 0.01), cardiac output (p = 0.03), FMD (p < 0.01), NTD (p = 0.01), and FMD/NTD ratio (p = 0.02). Although the total volume of intravenous fluid transfused was higher in the pulmonary edema group, the net fluid retention during surgery was statistically insignificant. The lengths of intensive care unit stay and hospitalization, as well as mortality rates, were not different in these groups.


CONCLUSIONS
The high incidence of pulmonary edema after living donor liver transplantation was associated with a high FMD and FMD/NTD ratio at pretransplantation. FMD is the only significant predictor associated with pulmonary edema. However, we observed no alteration in mortality rates.


BACKGROUND
Cirrhotic cardiomyopathy; Flow-mediated vasodilatation; Liver transplantation; Pulmonary edema.
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine;
Shyh-Ming
SM
Chen
Chang Gung University College of Medicine; ; Liver Transplant Program and Department of Surgery;
Chao-Long
CL
Chen
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine;
Han-Tan
HT
Chai
Chang Gung University College of Medicine; ; Liver Transplant Program and Department of Surgery;
Chee-Chien
CC
Yong
Chang Gung University College of Medicine; ; Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung;
Hsien-Wen
HW
Hsu
Chang Gung University College of Medicine; ; Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung;
Yu-Fan
YF
Cheng
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine;
Morgan
M
Fu
Department of Gerontological Care and Management, Chang Gung Institute of Technology, Taoyuan, Taiwan.
Yu-Tung Anton
YT
Huang
Section of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital; ; Chang Gung University College of Medicine;
Chi-Ling
CL
Hang