Hemodynamics During Liver Transplantation: the Interactions Between Cardiac Output and Portal Venous and Hepatic Arterial Flows

Abstract

Liver blood flow and systemic hemodynamics were measured intraoperatively in 34 patients after liver transplantation. Ultrasound transit-time flow probes measured hepatic arterial and portal venous flow over 10 to 75 min 1 to 3 hr after reperfusion. Cardiac output was measured by thermodilution. Mean cardiac output was 9.5 +/- 2.8 L/min; the mean total liver blood flow of 2,091 +/- 932 ml/min was 23% +/- 11% of cardiac output. Mean portal flow of 1,808 +/- 929 ml/min was disproportionately high at 85% +/- 10% of total liver blood flow. Correlation analysis showed a significant (p less than 0.01; r = 0.42) correlation between cardiac output and portal venous flow and a trend toward negative correlation (p = 0.087) between cardiac output and hepatic arterial flow. These data show that increased flow in the newly transplanted liver is predominantly portal venous flow and is associated with high cardiac output and reduced hepatic arterial flow. In the last 13 patients studied, portal flow was reduced by 50% and the hepatic artery response was measured. We saw a significant (p less than 0.05) increase in hepatic artery flow from 322 +/- 228 to 419 +/- 271 ml/min, indicating an intact hepatic arterial buffer response. The hepatic artery response also showed that it is a reversible rather than a fixed resistance that contributes to the low hepatic artery flow in these patients.

Kupffer cell-dependent TNF-α signaling mediates injury in the arterialized small-for-size liver transplantation in the mouse

“…It is tempting to correlate these findings with a number of clinical observations showing increased portal pressure and possibly flow in smallfor-size OLT, with a beneficial effects of a variety of strategies decreasing portal pressure such as porto-systemic shunt (30). We would postulate here that high portal pressure͞flow induces arterial vasoconstriction as shown in many studies looking at the respective role of portal and arterial flow to the liver (31)(32)(33). Poor arterial flow is possibly one of the most significant factor for graft survival after OLT in humans and mice (19,34).…”

Hemodynamic consequences of spontaneous splenorenal shunts in deceased donor liver transplantation

“…[22][23][24] We decided to occlude the LRV when the flow was less than or equal to 1200 mL/minute. Only 2 studies using a transit time flowmeter (MediStim) and addressing the same topic in whole liver transplantation have been reported previously.…”

Changes in portal vein flow after adult living-donor liver transplantation: Does it influence postoperative liver function?

“…16 During liver transplantation, these alterations are maintained, but they tend to disappear during the following months. [17][18][19] This hyperdynamic state has not been a serious problem in cadaveric liver transplantation, in which a whole organ is placed orthotopically. However, in adult LDLT, in which only part of the liver is transplanted, these hemodynamic changes may be the cause of the pathophysiologic state known as the SFS.…”