INTROPERATIVE CARDIAC PROFILES IN RECIPIENTS OF LIVE DONOR LIVER TRANSPLANTATION SURGERY

Abstract

P497 Introduction: Orthotopic liver transplantation (OLT) utilizing partial liver grafts from live donors has proven to be a viable option in an era of donor organ shortage. Ischemia time and preservation injury are minimized (<2 hours) when live donor liver transplantation (LDLT) is performed. OLT can be divided into several operative stages: dissection phase (stage I), the anhepatic/vascular anastomosis phase (stage II) and the phase after reperfusion of the donor graft (stage III). Methods: Fifty adult patients, mean age of 50 ±11.5 years, who underwent LDLT between November 2000 and February 2004 were studied. Etiologies were alchohol-induced cirrhosis (n=12), hepatitis B and C induced cirrhosis (n=11), primary sclerosing cholangitis (n=11), primary biliary cirrhosis (n=7), nonalcoholic steatotic hepatitis (NASH, n=3) and others (n=6). Intraoperative hemodynamic monitoring included mean arterial pressure (MAP), mean pulmonary artery pressure (mPAP), pulmonary capillary wedge pressure (PCWP) and central venous pressure (CVP). Continuous cardiac output (CO), mixed venous saturation (SvO2), right ventricular ejection fraction (RVEF), and right ventricular end-diastolic volume (RVEDV) were also measured, together with metabolic parameters: pH, base excess (BE); serum sodium (Na+); serum potassium (K+); ionized calcium (Ca++); lactate and osmolarity. The Mann-Whitney test was used. p < 0.05 was considered statistically significant. All data are presented as mean values ± SD. Results: Compared with the baseline, MAP decreased to 72 ± 14 mmHg 5 minutes after reperfusion (III+5). Significant hypotension, defined as MAP ≤ 59 mmHg [1], occurred in 15 % of patients at III+5. In addition, PAP and K+ remained stable at III+5, while CVP decreases. Average epinepherine doses given at reperfusion was 24 ± 27 mcg. TABLE 1: Hemodynamic and Metabolic Profiles During LDLTFigureConclusions: The results of this study show a low incidence of hypotension (15 %), decreasing CVP, and stable mPAP and K+ values after reperfusion of the donor graft in LDLT recipients. These findings contrast changes described in the “Post Reperfusion Syndrome” (PRS), where hypotension can occur in 29% of patients, and elevations of CVP, PAP and K+ were observed [2]. Since donor organs for LDLT are from healthy individuals, there should be no hypotension or oxygen delivery issues involving the donor grafts, and preservation/ischemic injury should be minimal. Therefore, one could predict that the incidence of hypotension and PRS may be lower in LDLT, as was shown in this series of patients. Understanding this is required for optimal patient management and more studies should be undertaken to verify and explain these findings. Maintaining euvolemia prior to reperfusion may further decrease this reported low incidence of hypotension. Transplantation, Volume 78, Number 2, July 27, 2004