title: Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation.
abstract: Advanced liver cirrhosis is usually accompanied by portal hypertension. Long-term portal hypertension results in various vascular alterations. The systemic hemodynamic state in patients with cirrhosis is termed a hyperdynamic state. This peculiar hemodynamic state is characterized by an expanded blood volume, high cardiac output, and low total peripheral resistance. Vascular alterations do not disappear even long after liver transplantation (LT), and recipients with cirrhosis exhibit a persistent systemic hyperdynamic state even after LT. Stability of optimal systemic hemodynamics is indispensable for adequate portal venous flow (PVF) and successful LT, and reliable parameters for optimal systemic hemodynamics and adequate PVF are required. Even a subtle disorder in systemic hemodynamics is precisely indicated by the balance between cardiac output and blood volume. The indocyanine green (ICG) kinetics reflect the patient's functional hepatocytes and effective PVF, and PVF is a major determinant of the ICG elimination constant (kICG) in the well-preserved allograft. The kICG value is useful to set the optimal PVF during living-donor LT and to evaluate adequate PVF after LT. Perioperative management has a large influence on the postoperative course and outcome; therefore, key points and unexpected pitfalls for intensive management are herein summarized. Transplant physicians should fully understand the peculiar systemic hemodynamic behavior in LT recipients with cirrhosis and recognize the critical importance of PVF after LT.
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Hori
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogura
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Onishi
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Hideya
authors.initials: H
authors.lastname: Kamei
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Kurata
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Motoshi
authors.initials: M
authors.lastname: Kainuma
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ichikawa
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Mizuno
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Aoyama
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ishida
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hirai
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Kazuko
authors.initials: K
authors.lastname: Hasegawa
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Hiromu
authors.initials: H
authors.lastname: Takeichi
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Atsunobu
authors.initials: A
authors.lastname: Ota
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugimoto
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Iida
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yagi
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Taniguchi
authors.affiliation: Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Uemoto
keywords: Hyperdynamic; Indocyanine green; Liver cirrhosis; Liver transplantation; Portal hypertension