Perioperative use of terlipressin abrogates the early postoperative decline in renal function of patients who have chronic liver disease and undergo liver transplantation without any detrimental effect on hepatosplanchnic gas exchange and lactate metabolism.

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Ornithine transcarbamylase (OTC) deficiency (OTCD) is an X-linked urea cycle disorder. Being an X-linked disease, the onset and severity of the disease may vary among female carriers. Some of them start to develop the disease early in life, whereas others remain asymptomatic throughout their lives. Our patient was a 42-year-old man who developed severe hyperammonemia and fatal brain edema after receiving a right lobe graft from an asymptomatic female living donor with unrecognized OTCD. The donor developed hyperammonemia and disturbed level of consciousness that was managed successfully by hemodialysis. Molecular testing of the OTC gene in the donor revealed a heterozygous nonsense mutation (c.429T > A) in exon 5.

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Background: to assess the validity of Central and Pulmonary CO2 gaps to predict and guide fluid management during liver transplantation. Methods: Intraoperative fluid management was guided by pulse pressure variations (PPV). PPV of ≥15% triggered fluid resuscitation with 250 ml albumin 5% boluses to restoret PPV to <15%. Simultaneous blood sampling from central venous and pulmonary artery catheters (PAC) were clolected to calculate central and pulmonary CO2 gap. Patients were considered Fluid Responsive (FRS) if fluid boluses restored PPV to <15% and Fluid non-Responsive (FnRS) if not. CO and lactate and their correlation to CO2 gaps were also recorded. Results: The discriminative ability of Central and Pulmonary CO2 gaps between the two statuses (FRS and FnRS) was poor. AUC of ROC were 0.698 and 0.570 respectively. The Central CO2 gap was significantly higher in FRS than FnRS (P=0.016), with no difference in Pulmonary CO2 gap between both statuses. conclusion: Central and the Pulmonary CO2 gaps cannot be used alone as valid tools to predict fluid responsiveness and guide fluid management during liver transplantation. CO2 gaps do not correlate well with the changes in PPV or CO Trial registration: Clinicaltrials.gov NCT03123172. Registered on 31-march-2017

Background To assess the validity of central and pulmonary veno-arterial CO 2 gradients to predict fluid responsiveness and to guide fluid management during liver transplantation. Methods In adult recipients (ASA III to IV) scheduled for liver transplantation, intraoperative fluid management was guided by pulse pressure variations (PPV). PPV of ≥15% (Fluid Responding Status-FRS) indicated fluid resuscitation with 250 ml albumin 5% boluses repeated as required to restore PPV to < 15% (Fluid non-Responding Status-FnRS). Simultaneous blood samples from central venous and pulmonary artery catheters (PAC) were sent to calculate central venous to arterial CO 2 gap [C(v-a) CO2 gap] and pulmonary venous to arterial CO 2 gap [Pulm(p-a) CO2 gap]. CO and lactate were also measured. Results Sixty seven data points were recorded (20 FRS and 47 FnRS). The discriminative ability of central and pulmonary CO 2 gaps between the two states (FRS and FnRS) was poor with AUC of ROC of 0.698 and 0.570 respectively. Central CO 2 gap was significantly higher in FRS than FnRS ( P = 0.016), with no difference in the pulmonary CO 2 gap between both states. The central and Pulmonary CO 2 gaps are weakly correlated to PPV [r = 0.291, ( P = 0.017) and r = 0.367, ( P = 0.002) respectively]. There was no correlation between both CO 2 gaps and both CO and lactate. Conclusion Central and the Pulmonary CO 2 gaps cannot be used as valid tools to predict fluid responsiveness or to guide fluid management during liver transplantation. CO 2 gaps also do not correlate well with the changes in PPV or CO. Trial registration Clinicaltrials.gov Identifier: NCT03123172 . Registered on 31-march-2017.