During the anhepatic phase of conventional liver transplantation (LT), the inferior vena cava (IVC) is crossclamped and venovenous bypass (VVB) is usually indicated for diversion of IVC and portal blood flow. VVB can theoretically lead to pulmonary complications due to the contact of the blood with the surfaces of the circuit. In the piggyback method, preservation of the IVC avoids VVB. The aim of this study is to compare pulmonary alterations after conventional with VVB versus piggyback LT. Sixtyseven patients were randomized for conventional VVB (n ؍ 34) or piggyback (n ؍ 33) LT. Pulmonary static compliance (C st ) and Pa O2 /F IO2 ratio were measured preand post-LT. Chest X-rays were obtained daily from the 1st to the 5th postoperative day. Pre-and post-LT C st were 73.4 ؎ 36.0 mL/cm H 2 O and 59.7 ؎ 22.0 mL/cm H 2 O in the conventional group and 69.1 ؎ 20.0 mL/cm H 2 O and 58.7 ؎ 27.1 mL/cmH 2 O in the piggyback group. The difference between the two groups was not significant (P ؍ .702). C st significantly decreased after LT (P ؍ .008). The pre-and post-LT Pa O2 /F IO2 were 455.6 ؎ 126.6 mm Hg and 463.1 ؎ 105.9 mm Hg in the conventional group and 468.9 ؎ 114.1 mm Hg and 483.3 ؎ 119.8 mm Hg in the piggyback group. The difference among the two groups was not significant (P ؍ 0.331). There was no significant difference after LT (P ؍ .382). Upon the radiological evaluation, piggyback group presented a higher frequency of pulmonary infiltrates (80.6% vs. 50.0%; P ؍ .025). In conclusion, piggyback LT recipients have a higher rate of pulmonary infiltrates when compared to those operated upon using the conventional VVB method. (Liver Transpl 2004;10:425-433.) C urrently, 2 main methods of liver transplantation (LT) are employed. 1 In the conventional method, the retrohepatic portion of the inferior vena cava (IVC) is cross-clamped and resected in block with the native liver. This maneuver can lead to pulmonary complications secondary to the temporary reduction of the venous blood return of the lower extremities and splanchnic bed. 2 Patients with poor hemodynamic tolerance to IVC and portal vein clamping will require fluid infusion during the anhepatic phase. 2 After graft reperfusion, the restoration of the venous return results in a sudden central volume overload that can cause pulmonary edema. 2 A concurrent mechanism is the release into the systemic circulation of proinflammatory substances produced in the graft itself during the ischemia-reperfusion injury, and in the obstructed venous beds during blood stagnation. 3 These substances may produce left ventricle dysfunction, increase pulmonary capillary pressure, and alter capillary permeability. 3 All these actions can contribute to pulmonary dysfunction.To overcome these disorders, venovenous bypass (VVB) is usually indicated, allowing the diversion of the IVC and portal blood flow to the superior vena cava. 2 Despite these advantages, VVB can also cause pulmonary complications. Although rare, some can be fatal, like air or thrombotic pulmonary em...
Objetivo: Avaliar o efeito das medidas pré-operatórias das pressões inspiratória máxima (PImáx) e expiratória máxima (PEmáx) no resultado do transplante de fígado (Tx). Métodos: Foram estudados retrospectivamente 228 pacientes submetidos a primeiro Tx eletivo. Os pacientes foram classificados conforme a ocorrência de valores absolutos de pressão respiratória menores ou iguais a 50 cm H2O. As variáveis estudadas foram: tempo de ventilação mecânica pós-operatória, necessidade de re-intubação orotraqueal ou de ventilação mecânica não-invasiva, tempo de internação e sobrevida. Resultado: Os resultados mostraram que os valores observados de PImáx e PEmáx estavam abaixo de 50 cm H2O em 19,7% (45/228) e 14,5% (33/228) dos pacientes, respectivamente. A freqüência de óbito até seis meses após o transplante foi de 26/183 (14,2%) nos pacientes com PImáx > 50 cm H2O e de 15/45 (33,3%) nos pacientes com PImáx mais baixa (p=0,003). A sobrevida de 1, 3 e 5 anos foi 84%, 77% e 71% no grupo com PImáx > 50 cm H2O e 57%, 50% e 50% no grupo com PImáx mais baixa (p=0,0024). Em relação à PEmáx, essas probabilidades foram 80%, 74% e 69% no grupo com valores maiores que 50 cm H2O e 66%, 59% e 51% nos pacientes com força expiratória menor (p=0,1039). Não houve diferença estatisticamente significante em relação às demais variáveis analisadas. Conclusão: Pacientes com PImáx baixa apresentam maior mortalidade após o Tx. Entretanto, não foram encontrados efeitos estatisticamente significantes da medida pré-operatória da força da musculatura respiratória nas variáveis de resposta mais diretamente relacionadas com alterações respiratórias.
Força muscular e mortalidade na lista de espera de transplante de fígado (Réplica dos autores)
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