Stability of cirrhotic systemic hemodynamics ensures sufficient splanchnic blood flow after living-donor liver transplantation in adult recipients with liver cirrhosis |
| |
Authors: | Hori Tomohide Yagi Shintaro Iida Taku Taniguchi Kentaro Yamagiwa Kentaro Yamamoto Chiduru Hasegawa Takashi Yamakado Koichiro Kato Takuma Saito Kanako Wang Linan Torii Mie Hori Yukinobu Takeda Kan Maruyama Kazuo Uemoto Shinji |
| |
Affiliation: | 1. Departments of Hepatobiliary Pancreatic Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan 2. Department of Hepatobiliary Pancreatic and Transplant Surgery, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan 3. Department of Anesthesiology and Critical Care Medicine, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan 4. Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan 5. Department of Medical Oncology and Immunology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan 6. Department of Cellular and Molecular Immunology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan 7. Nagoya Economic University Graduate School of Law, 61-1 Uchikubo, Inuyama City, Aichi Prefecture, 484-8504, Japan |
| |
Abstract: | AIM: To investigate the correlation between systemic hemodynamics and splanchnic circulation in recipients with cirrhosis undergoing living-donor liver transplantation (LDLT), and to clarify how systemic hemodynamics impact on local graft circulation after LDLT. METHODS: Systemic hemodynamics, indocyanine green (ICG) elimination rate (KICG) and splanchnic circulation were simultaneously and non-invasively investigated by pulse dye densitometry (PDD) and ultrasound. Accurate estimators of optimal systemic hyperdynamics after LDLT [i.e., balance of cardiac output (CO) to blood volume (BV) and mean transit time (MTT), defined as the timerequired for half the administered ICG to pass through an attached PDD sensor in the first circulation] were also measured. Thirty recipients with cirrhosis were divided into two groups based on clinical outcomes corresponding to postoperative graft function. RESULTS: Cirrhotic systemic hyperdynamics characterized by high CO, expanded BV and low total peripheral resistance (TPR) were observed before LDLT. TPR reflecting cirrhotic vascular alterations was slowly restored after LDLT in both groups. Although no significant temporal differences in TPR were detected between the two groups, CO/BV and MTT differed significantly. Recipients with good outcomes showed persistent cirrhotic systemic hyperdynamics after LDLT, whereas recipients with poor outcomes presented with unstable cirrhotic systemic hyperdynamics and severely decreased KICG. Systemic hyperdynamic disorders after LDLT impacted on portal venous flow but not hepatic arterial flow. CONCLUSION: We conclude that subtle systemic hyperdynamics disorders impact on splanchnic circulation, and that an imbalance between CO and BV decreases portal venous flow, which results in critical outcomes. |
| |
Keywords: | Cirrhosis Hyperdynamic Portal hypertension Splanchnic Indocyanine green |
本文献已被 CNKI 维普 万方数据 PubMed 等数据库收录! |
|