Abstract
O22 Aims: To study the outcome of splanchnic and systemic hemodynamics early after living donor liver transplantation. Methods: The influence of hemodynamic changes on liver function was determined as well. Portal vein velocity and diameter were measured prospectively using Doppler-ultrasound in 23 consecutive recipients with cirrhosis, before and 1, 7, 14 and 30 days after living related right lobe liver transplantation. Portal blood flow (PBF) was calculated. Liver function tests were obtained at the same time-periods. Hepatic venous pressure gradient (HVPG) was determined at day 7 and a transyugular liver biopsy was performed. Hemodynamic results were compared with those preoperatively obtained in donors. Results: The mean graft/recipient weight ratio (GRWR) was 1.01±0.23. Fourteen patients were Child B and 9 were Child C. The mean right PBF in recipients at day 1 was significantly higher than in donors (1.55±0.34 vs 0.89±0.26 L/min, p<0.01). The main determinant of elevated PBF in recipients was the increase in right portal vein velocity (86±21 vs 48±13 cm/sec, p<0.01). GRWR did not differ between Child B and C patients. However, PBF was significantly higher in Child C patients (1.61±0.33 vs 1.38±0.35 L/min, p<0.05). PBF decreased significantly at 1 month but did not achieve normal values. When PBF was analyzed in relation to right lobe volume (PBF/RLV), the mean value of this ratio at day 1 significantly correlated with bilirubin value at day 7 (r = 0.78; p<0.01). HVPG at day 7 was increased (8.5±2.7 mmHg) and correlated closely with PBF/RLV at day 1 (r= 0.70; p<0.01). Histological findings were not related to hemodynamic or biochemical changes. Cardiac output was increased at all time-points but did not correlate with PBF or biochemical changes. Conclusions: Portal blood flow markedly increases early after living related right lobe liver transplantation. Changes in splanchnic hemodynamics may influence the outcome of liver function. Doppler ultrasound is a useful tool for the early detection of hemodynamic changes in these patients.
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