Hemodynamics in the immediate post-transplantation period in alcoholic and viral cirrhosis

Abstract

To study the hemodynamics in the immediate post transplant period and compare patients with alcoholic vs viral cirrhosis. Between 2000-2003, 38 patients were transplanted for alcoholic cirrhosis and 28 for postviral cirrhosis. Heart rate (HR), central venous pressure (CVP), mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), systemic vascular resistance index (SVRI), pulmonary artery pressure (PAP), and pulmonary vascular resistance index (PVRI) were measured immediately and 24 h post transplantation. Hyperdynamic circulation persisted at 24 h following transplantation with an elevated CI of 5.4 +/- 1.3 L/(min x m(2)) and 4.9 +/- 1.0 L/(min x m(2)) in the viral and alcoholic groups, respectively, and was associated with a decreased SVRI. Within the first 24 h, there was a significant decrease in HR and increase in MAP; the extent of the change was similar in both groups. The CVP, PCWP, and SVRI increased, and CI decreased in the viral patients, but not the alcoholic patients. Alcoholics showed a lower PVRI (119 +/- 52 dynes/(cm(5) x m(2)) vs 166 +/- 110 dynes/(cm(5) x m(2)), P < 0.05) and PAP (20 +/- 7 mmHg vs 24 +/- 7 mmHg, P < 0.05) compared to the viral group at 24 h. Hyperdynamic circulation persists in the immediate post-transplant period with a faster improvement in the viral group. Alcoholic patients have a more pronounced pulmonary vasodilatation.