Validity of right ventricular end-diastolic volume as a guide for fluid resuscitation compared with central venous pressure in living donor liver transplantation recipients: a randomized controlled trial

Abstract

Background Fluid transfusion inflects major impact on graft and renal functions in living donor liver transplantation. Major hemodynamic swinging renders intraoperative preload assessment crucial yet difficult task. In this prospective randomized double-blind controlled trial, we examined the validity of right ventricular end-diastolic volume (RVEDV) as a preload indicator compared with central venous pressure (CVP) in recipients of living donor liver grafts. Patients and methods A total of 21 patients included in the study were randomly allocated into either the RVEDV group ( n = 11) or the CVP group ( n = 10) on the basis of the trigger for operative fluid resuscitation. Basal value for both right ventricular end-diastolic volume index (RVEDVI) and CVP was recorded after laparotomy. Fluids (albumin 4% or Voluven) were given in boluses of 250 ml when the triggering parameter decreased by 20% of its basal value. Hemodynamic data were recorded after laparotomy (basal), at the end of hepatectomy, before portal unclamping, 15 min after portal unclamping, and at skin closure. Total fluids infused, blood loss, early graft, and patient's outcomes were also recorded. Results Both groups were similar with respect to demographic and operative data. Fluids infused were significantly higher in the RVEDVI group compared with the CVP group. Cardiac output and stroke volume were significantly higher in the RVEDVI than in the CVP group starting at end of hepatectomy and thereafter. Urine output was significantly less in the CVP group compared with the RVEDVI group. Hypotensive episodes were greater in the CVP group compared with the RVEDVI group. RVEDVI and CVP did not correlate at any time point. No intergroup differences were observed with respect to early graft functions, serum creatinine, blood urea, ICU stay, 28th day graft, and patient survival. Conclusion RVEDV appears to be a more sensitive preload indicator and a trigger for fluid resuscitation compared with CVP; however, patient monitoring with either parameter did not significantly affect the patient outcome.