Abstract. – BACKGROUND: Previous investi- gations on risk factors for orthotopic liver trans- plantation (OLT) surgery have not analyzed he- modynamic aberrations in great detail. Moreover, the usefulness of esophageal Doppler monitor- ing has not been extensively studied in this clini- cal setting. The aim of this study was to evaluate if the occurrence of primary graft dysfunction (PGD) may be anticipated by hemodynamic in- dexes measured by esophageal Doppler (ED) monitoring system as well as by pulmonary artery catheter (PAC) in patients undergoing OLT. MATERIALS AND METHODS: 38 OLT recipi- ents were studied. Patients with acute liver fail- ure or having non treated esophageal varices and those transplanted with marginal donors were excluded from the study. The haemodynam- ic data – measured by ED monitoring system (HemosonicTM 100, Arrow, OK, USA) and PAC – collected at the following 3 time points were considered for statistical analysis: 30 minutes after the induction of anesthesia but before skin incision, T0; 20 minutes after liver dissection, T1; at the beginning of biliary reconstruction, T2. On the basis of early outcome (72 hours after OLT), patients were distinguished into two groups: those with PGD (grade III-IV of Toronto classifi- cation) and those without PGD (grade I-II). RESULTS: LVETc (left ventricular ejection time) values, registered at the beginning of biliary re- construction (T2), were lower in patients with PGD compared to those without PGD (p < 0.000), while there were no differences in hemodynamic para- meters derived from PAC between the two groups. CONCLUSIONS: Since LVETc is related to pre- load, the results of this study would suggest that normovolemia could be the end point of a fluid replacement strategy in OLT setting.

Perilli, V., Aceto, P., Modesti, C., Ciocchetti, P., Sacco, T., Vitale, F., Lai, C., Magalini, S., Avolio, A. W., Sollazzi, L., Low values of left ventricular ejection time in the post-anhepatic phase may be associated with occurrence of primary graft dysfunction after orthotopic liver transplantation: results of a single-centre case-control study, <<EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES>>, 2012; 2012 (Ottobre): 1433-1440 [http://hdl.handle.net/10807/37122]

Low values of left ventricular ejection time in the post-anhepatic phase may be associated with occurrence of primary graft dysfunction after orthotopic liver transplantation: results of a single-centre case-control study

Perilli, Valter;Aceto, Paola;Modesti, Cristina;Ciocchetti, Pierpaolo;Sacco, Teresa;Vitale, Filippa;Lai, Carlo;Magalini, Sabina;Avolio, Alfonso Wolfango;Sollazzi, Liliana
2012

Abstract

Abstract. – BACKGROUND: Previous investi- gations on risk factors for orthotopic liver trans- plantation (OLT) surgery have not analyzed he- modynamic aberrations in great detail. Moreover, the usefulness of esophageal Doppler monitor- ing has not been extensively studied in this clini- cal setting. The aim of this study was to evaluate if the occurrence of primary graft dysfunction (PGD) may be anticipated by hemodynamic in- dexes measured by esophageal Doppler (ED) monitoring system as well as by pulmonary artery catheter (PAC) in patients undergoing OLT. MATERIALS AND METHODS: 38 OLT recipi- ents were studied. Patients with acute liver fail- ure or having non treated esophageal varices and those transplanted with marginal donors were excluded from the study. The haemodynam- ic data – measured by ED monitoring system (HemosonicTM 100, Arrow, OK, USA) and PAC – collected at the following 3 time points were considered for statistical analysis: 30 minutes after the induction of anesthesia but before skin incision, T0; 20 minutes after liver dissection, T1; at the beginning of biliary reconstruction, T2. On the basis of early outcome (72 hours after OLT), patients were distinguished into two groups: those with PGD (grade III-IV of Toronto classifi- cation) and those without PGD (grade I-II). RESULTS: LVETc (left ventricular ejection time) values, registered at the beginning of biliary re- construction (T2), were lower in patients with PGD compared to those without PGD (p < 0.000), while there were no differences in hemodynamic para- meters derived from PAC between the two groups. CONCLUSIONS: Since LVETc is related to pre- load, the results of this study would suggest that normovolemia could be the end point of a fluid replacement strategy in OLT setting.
2012
Inglese
Perilli, V., Aceto, P., Modesti, C., Ciocchetti, P., Sacco, T., Vitale, F., Lai, C., Magalini, S., Avolio, A. W., Sollazzi, L., Low values of left ventricular ejection time in the post-anhepatic phase may be associated with occurrence of primary graft dysfunction after orthotopic liver transplantation: results of a single-centre case-control study, <<EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES>>, 2012; 2012 (Ottobre): 1433-1440 [http://hdl.handle.net/10807/37122]
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/37122
Citazioni
  • ???jsp.display-item.citation.pmc??? 6
  • Scopus 18
  • ???jsp.display-item.citation.isi??? 17
social impact