Functional hepatic venous outflow and its correlation with early graft function in live donor liver transplantation

Abstract

Introduction: To evaluate the effect of central venous pressure (CVP) on early graft function in live donor liver transplantation (LDLT). Methods: 61 Recipients of LDLT without any technical complications from May 2013 to November 2014 were included. CVP was measured at five time points – before surgery, anhepatic phase, 30 minutes after reperfusion, end of surgery and post operatively (days 1–5). Patients were divided into two groups based on CVP ≤10, >10 mm Hg at various time points for analysis. Results: Elevated postoperative CVP (p ≤ 0.001) and drain culture positivity in the first week (p < 0.001) were found to be independent predictors of mortality on multivariate analysis. Optimum cut off of CVP in predicting mortality is 10.8. High cardiac output at the end of surgery (p = 0.005), high MELD scores (p = 0.011) and culture proven infection at any site (p = 0.002) were all independent predictors of early graft dysfunction (EGD) on multivariate analysis. There was an inverse correlation between CVP and SVR at the beginning of surgery which reversed to a positive correlation at the end of surgery. Conclusions: Elevated CVP in the postoperative period in recipients is a risk factor of mortality in the setting of LDLT. EGD is associated with high MELD scores, higher cardiac output at the end of surgery and infection at any site. A restrictive fluid management protocol aiming for a CVP <11 seems beneficial.