Hemodynamic and Metabolic Changes in Hepatic Transplantation

Rettke, Steven R.; Jánossy, T; Chantigian, Robert C.; Burritt, Mary F.; Dyke, Russell A. Van; Harper, James V.; Ilstrup, Duane M.; Taswell, Howard F.; Wiesner, Russell H.; Krom, Ruud A.F.

doi:10.1016/s0025-6196(12)65678-x

Cited by 46 publications

(27 citation statements)

References 16 publications

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“…The 13% reduction in MAP after VVBP observed in the reperfusion phase corresponds with hemodynamic changes previously reported in this phase of OLT [1,2,8,16,27,311. The use of VVBP might lead to a decrease in heart rate, possibly due to the decrease in body temperature that occurs if a heat exchanger is not used [24].…”

Section: Resultssupporting

confidence: 83%

Percutaneous technique for venovenous bypass including a heat exchanger is safe and reliable in liver transplantation

Scholz¹,

Aasen²,

Mathisen³

et al. 1997

Transplant Int

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We have introduced and evaluated several modifications of the conventional venovenous bypass (VVBP) in 29 adult patients undergoing liver transplantation (OLT). A percutaneous technique for insertion of a jugular venous return cannula and a femoral vein cannula was applied. The inferior mesenteric vein (IMV) was used for splanchnic decompression, which facilitated dissection of the recipient liver and allowed portal anastomosis to be performed without disconnecting the portal bypass. A heat exchanger was introduced into the bypass circuit to prevent heat loss. The percutaneous technique prevented complications related to dissection in the axilla and groin. Hemodynamic characteristics corresponded to those found using the traditional technique. Complications related to the VVBP were seen in only one patient in whom the femoral catheter was accidentally introduced into the femoral artery. We conclude that percutaneous cannulas, use of the IMV for splanchnic decompression and the introduction of a heat exchanger offer significant benefits and that they are safe and reliable.

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Section: Resultssupporting

confidence: 83%

Percutaneous technique for venovenous bypass including a heat exchanger is safe and reliable in liver transplantation

Scholz¹,

Aasen²,

Mathisen³

et al. 1997

Transplant Int

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Section: Discussionmentioning

confidence: 99%

“…Marked changes occur during the procedure, especially at the time of reperfusion [16,17]. These include a significant decrease in blood pressure, a decrease in systemic vascular resistance, an increase in cardiac output, a decrease in pH, an increase in lactate, an increase in potassium, and a prolongation of prothrombin time [16,17]. Although some of these abnormalities start to normalize during the final stages of surgery, some will persist into to the immediate postoperative period [16] and will be reflected on any severity of illness score such as APACHE II.…”

Section: Discussionmentioning

confidence: 99%

External validation of a modified model of Acute Physiology and Chronic Health Evaluation (APACHE) II for orthotopic liver transplant patients

et al. 2002

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Correspondence: Yaseen Arabi, yaseenarabi@yahoo.com APACHE = Acute Physiology and Chronic Health Evaluation; CI = confidence interval; GCS = Glasgow Coma Score; ICU = intensive care unit; OLTX = orthotopic liver transplantation; ROC = receiver operating characteristic; SMR = standardized mortality ratio. AbstractIntroduction The purpose of the study was to validate the newly derived postoperative orthotopic liver transplantation (OLTX)-specific diagnostic weight for the Acute Physiology and Chronic Health Evaluation (APACHE) II mortality prediction system in independent databases. Methods Medical records of 174 liver transplantation patients admitted postoperatively to the adult intensive care units at King Fahad National Guard Hospital and the University of Wisconsin were reviewed, and data on age, sex, the underlying liver disease, APACHE II scores and the hospital outcome were collected. Predicted mortality was calculated using: 1) the original APACHE II diagnostic weight of postoperative other gastrointestinal surgery and 2) the newly derived OLTXspecific diagnostic category weight. Standardized mortality ratio and 95% confidence intervals were calculated. Calibration was evaluated with the Hosmer-Lemeshow goodness-of-fit C-statistic. Discrimination was tested by 2 × 2 classification matrices and by computing the areas under the receiver operating characteristic curves. Patient characteristics and outcome data were compared between the two hospitals. Results APACHE II significantly overestimated mortality when the original diagnostic weight was used, but provided a closer estimate of mortality with the OTLX-specific diagnostic weight. The C-statistic analysis showed better calibration for the new approach; discrimination was also improved. The performances of the prediction systems were similar in the two hospitals. The new model provided more accurate estimates of hospital mortality in each hospital. Discussion APACHE II provided an accurate estimate of mortality in liver transplant patients when the OLTX-specific diagnostic weight was used. With the new model, APACHE II can be used as a valid mortality prediction system in this group of patients.

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“…6 Similar results were found by other authors. 7,8 Therefore, in our institution it is established that no transfusions of FFP, clotting factors, or platelets are administered preoperatively. Only in patients with acute liver failure, FFP is given to keep PT values greater than 20% and RDPs are transfused to maintain platelets greater than 15,000 nL/mL preoperatively.…”

confidence: 99%

Coagulation techniques are not important in directing blood product transfusion during liver transplantation

Reyle-Hahn

Rossaint

1997

Liver Transpl

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Preoperative acquired clotting parameters such as prothrombin time, activated partial thromboplastin time, antithrombin III, platelet concentration, and fibrinogen show coagulopathy caused by insufficiency of the diseased liver. Intraoperative determination of clotting factors or parameters is not helpful to direct intraoperative transfusion of blood, blood components, or platelets because transfusions performed solely for correction of clotting data do not correlate with the real intraoperative requirements and increase the costs of orthotopic liver transplantation. However, the use of antihyperfibrinolytic drugs seems to reduce intraoperative blood loss. Patients with cirrhotic disorders caused by portalvenous hypertension show extensive collaterals and increased intravascular blood volume. Thus it is plausible that especially overcorrection of blood loss during the surgical preparation in the preanhepatic phase of the operation results in extensive blood loss. Therefore, to avoid blood loss we attempt to keep volume substitution to a minimum during the preanhepatic phase of the operation. In contrast, during the anhepatic and postanhepatic phases we attempt to reestablish normovolemia by transfusing red packed blood cells and fresh-frozen plasma. Strictly confined use of blood products in the preanhepatic phase, followed by later correction of intravascular blood volume, may reduce intraoperative blood loss; it also seems to ensure adequate substitution of clotting factors.

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Hemodynamic and Metabolic Changes in Hepatic Transplantation

Cited by 46 publications

References 16 publications

Percutaneous technique for venovenous bypass including a heat exchanger is safe and reliable in liver transplantation

Percutaneous technique for venovenous bypass including a heat exchanger is safe and reliable in liver transplantation

External validation of a modified model of Acute Physiology and Chronic Health Evaluation (APACHE) II for orthotopic liver transplant patients

Coagulation techniques are not important in directing blood product transfusion during liver transplantation

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