ADDITIONAL DOSE OF APROTININ MAY IMPROVE HEMODYNAMICS DURING POSTREPERFUSION PERIOD IN PATIENTS UNDERGOING ORTHOTOPIC LIVER TRANSPLANTATION (OLT)

Abstract

S123 The role of possible antiinflammatory effects of Aprotinin (APR) in different clinical situations has been reported [1]. The positive influence of APR on hemodynamics during OLT was recognized as well [2]. The reperfusion of the transplanted liver graft by unclamping inferior vena cava and portal vein causes depression of cardiovascular system. The most common findings are: hypotension, bradyrrhythmia, low systemic vascular resistance, increased venous filling pressure, decreased cardiac output and myocardial depression. This could be related to vasoactive substances or myocardial depressant factors released from the grafted liver [3]. We assessed the effects of additional dose of APR given before reperfusion on hemodynamics during postreperfusion period. METHODS: Eighteen patients, aged 36-66, who underwent OLT without veno-venous bypass (VVB) were given APR in high dose: 2,000,000 kallikrein inactivation units (KIU) at the beginning of surgery followed by continuous infusion of 500,000 KIU/h until the end of surgery. Patients were divided into two groups: nine patients received 500,000 KIU of APR 5 min before reperfusion. The second group of 9 patients did not. The following hemodynamic data were recorded 5 min before and 5 min after reperfusion: mean arterial pressure (MAP), central venous pressure (CVP), mean arterial pulmonary pressure (PAP-M), pulmonary artery wedge pressure (PAWP), systemic vascular resistance (SVR), and cardiac index (CI). Statistical analysis was done using Student's t-test, and p < 0.05 was considered as significant. RESULTS: No significant differences were found regarding age, weight, Child's classification of liver failure, and hemodynamics before reperfusion. Significantly higher SVR, MAP, a lower PAP-M, CVP, and trend toward lower PAWP and CI were noted in APR group. (Table 1)Table 1CONCLUSIONS: These results suggest that additional dose of APR before reperfusion may improve hemodynamics during postreperfusion period. These findings could be explained by possible antiinflammatory effects of APR. Higher dose of APR may be needed to achieve these effects.