Hemodynamic changes in splanchnic circulation after orthotopic liver transplantation in patients with liver cirrhosis

Effect of positive cumulative fluid balance on postoperative complications after living donor liver transplantation: A retrospective analysis

Background and Aims:

Fluid administration during liver transplant (LT) surgery is controversial. Although adverse outcomes following positive intraoperative fluid balance have been reported, studies presenting the influence of cumulative postoperative fluid balance (CFB) on complications following LT are sparse. Patients with chronic liver disease tend to receive more fluid during and after surgery due to their unique physiological disease state. The aim of this study was to evaluate the influence of 48-hour CFB on the development of acute kidney injury (AKI) and pulmonary complications on day 4 after live donor LT.

Methods:

This retrospective study included 230 patients undergoing live donor LT. The effect of CFB on day 2 on AKI and pulmonary complications was analysed. Chi-square test, Fisher's exact test, samples t-test, Mann-Whitney U-test were used.

Results:

Bivariate analysis showed a lower graft vs recipient weight ratio (GRWR), sepsis (P < 0.001) and a higher 48-hour CFB after surgery significantly increased the development of AKI. For pulmonary complications, higher Model for End- stage Liver Disease-Na(MELD-Na) score, higher peak arterial lactate, higher 48-hour CFB (P = 0.016) and sepsis (P = 0.003) were found to be statistically significant. Upon multivariate analysis, CFB at 48 hours was significantly higher in patients suffering from pulmonary complications, and GRWR and sepsis were significant for AKI. For every one litre increase in CFB on day 2, the odds of pulmonary complications increased by 37%.

Conclusion:

A more positive CFB on day 2 increased the development of pulmonary complications and lower GRWR and sepsis increased the development of AKI.

Severe thrombocytopenia before liver transplantation is associated with delayed recovery of thrombocytopenia regardless of donor type

AIM: To compare the recovery of thrombocytopenia and splenomegaly during long-term follow-up after liver transplantation in patients receiving a living donor transplant or a cadaveric donor transplant.

METHODS: This was a retrospective cohort study of 216 consecutive liver transplant patients who survived for > 6 mo after transplantation; 169 received a liver transplant from a living donor and 47 from a cadaveric donor. The platelet counts or spleen volumes were examined before transplant, 1, 6, and 12 mo after transplant, and then annually until 5 years after transplant.

RESULTS: The mean follow-up period was 49 mo (range, 21-66). Platelet counts increased continuously for 5 years after orthotopic liver transplant. The restoration of platelet counts after transplant was significantly slower in patients with severe pretransplant thrombocytopenia (< 50 000/μL) until 4 years after transplant (P = 0.005). Donor type did not significantly affect the recovery of platelet count and spleen volume in either patient group. In multivariate analysis, pretransplant severe thrombocytopenia (< 50 000/μL) was an independent factor associated with sustained thrombocytopenia (P < 0.001, odds ratio 6.314; confidence interval, 2.828-14.095). Thrombocytopenia reappeared after transplant in seven patients with portal flow disturbance near the anastomosis site.

CONCLUSION: Our study suggests that severe thrombocytopenia before transplant is closely associated with delayed recovery of platelet count after transplant and donor type did not affect the recovery of thrombocytopenia. The reappearance of thrombocytopenia after transplant should be considered a possible indicator of flow disturbance in the portal vein.

O uso dos índices de impedância da artéria esplênica na avaliação da hipertensão portal

OBJETIVO: Estudar os índices de impedância - índices de resistência (IR) e pulsatilidade (IP) - da artéria esplênica em pacientes com hepatopatia crônica. MATERIAIS E MÉTODOS: Foram estudados, prospectivamente, 42 pacientes com cirrose hepática e 21 pacientes com hepatite crônica. RESULTADOS: Foi observado que, nos pacientes com cirrose, ambos os índices estiveram elevados (IR = 0,63 ± 0,08 e IP = 1,02 ± 0,22) em comparação com os pacientes com hepatite crônica (IR = 0,58 ± 0,06 e IP = 0,89 ± 0,15) e os indivíduos do grupo controle (IR = 0,57 ± 0,04 e IP = 0,87 ± 0,11). Os cirróticos com evidência de circulação colateral à ultra-sonografia apresentaram, no entanto, menores índices de resistência (IR = 0,60 ± 0,08) em comparação com os cirróticos sem circulação colateral (IR = 0,65 ± 0,07), possivelmente devido ao shunt portossistêmico provocado pelos vasos colaterais. Não houve diferença significativa dos índices entre pacientes com e sem varizes esofagianas. CONCLUSÃO: O trabalho demonstrou que os índices de impedância da artéria esplênica podem ser úteis na avaliação de pacientes com hepatopatia crônica e hipertensão portal, contribuindo com dados adicionais à ultra-sonografia com eco-Doppler colorido.

Cardiac morbidity and mortality related to orthotopic liver transplantation

This article briefly discusses the cardiac status of liver transplant recipients and their preoperative cardiac evaluation. It describes in detail perioperative and early and late postoperative complications as well as the cardiac problems associated with immunosuppression. The preoperative cardiovascular status of patients is important in determining how they cope with the stresses imposed by liver transplantation. Minor early cardiac events are common and may influence longer term cardiac morbidity. Immunosuppressive therapy may have short term effects but is likely to adversely affect long term cardiac risk.