Cardiac Dysfunction During Liver Transplantation: Incidence and Preoperative Predictors

The interaction of systemic hemodynamics with hepatic flows at the time of liver transplantation (LT) has not been studied in a prospective uniform way for different types of grafts. We prospectively evaluated intraoperative hemodynamics of 103 whole and partial LT. Liver graft hemodynamics were measured using the ultrasound transit time method to obtain portal (PVF) and arterial (HAF) hepatic flow. Measurements were recorded on the native liver, the portocaval shunt, following reperfusion and after biliary anastomosis. After LT HAF and PVF do not immediately return to normal values. Increased PVF was observed after graft implantation. Living donor LT showed the highest compliance to portal hyperperfusion. The amount of liver perfusion seemed to be related to the quality of the graft. A positive correlation for HAF, PVF and total hepatic blood flow with cardiac output was found (p = 0.001). Portal hypertension, macrosteatosis >30%, warm ischemia time and cardiac output, independently influence the hepatic flows. These results highlight the role of systemic hemodynamic management in LT to optimize hepatic perfusion, particularly in LDLT and split LT, where the highest flows were registered.

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“…shown to be a cause of poor outcome (2,12,13). The normal liver has no active role in the physiological regulation of hepatic inflow.…”

Section: The Systemic Hemodynamics In Patients Undergoing Liver Transmentioning

confidence: 99%

Prospective Evaluation of Intraoperative Hemodynamics in Liver Transplantation with Whole, Partial and DCD Grafts

Sainz-Barriga

Reyntjens²,

Costa

et al. 2010

American Journal of Transplantation

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“…A significant proportion of patients with cirrhosis affected by ascites, volume overload, and signs of hyperdynamic circulation have normal resting echocardiographic parameters but abnormal cardiac responses during exertion, stress, TIPS, or liver transplantation, consistent with the existence of a cirrhotic cardiomyopathy (81). Strict diagnostic criteria for cirrhotic cardiomyopathy are lacking, and this syndrome is often not recognized.…”

Section: Discussionmentioning

confidence: 98%

“…Liver transplantation is also associated with cardiovascular complications (affecting almost 25% of patients), and patients with an abnormal heart function during surgery are at higher risk for post-operative pulmonary edema (81,82).…”

Section: Prognosismentioning

confidence: 99%

Cirrhotic Cardiomyopathy

Zardi

Abbate

Zardi

et al. 2010

Journal of the American College of Cardiology

313

276

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Cirrhotic cardiomyopathy is a clinical syndrome in patients with liver cirrhosis characterized by an abnormal and blunted response to physiologic, pathologic, or pharmacologic stress but normal to increased cardiac output and contractility at rest. As many as 50% of cirrhotic patients undergoing liver transplantation show signs of cardiac dysfunction, and 7% to 21% of deaths after orthotopic liver transplantation result from overt heart failure. In this review, we critically evaluate the existing literature on the pathophysiology and clinical implications of cirrhotic cardiomyopathy.

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“…9 Abnormal cardiac responses during transplantation have been related to a longer postoperative incubation peroid. 41 Interestingly, in that study, hyponatremia and indicators of effective hypovolemia predicted an abnormal cardiac response.…”

Section: Cardiac Function and Liver Transplantationmentioning

confidence: 96%

The heart: Pathophysiology and clinical implications of cirrhotic cardiomyopathy

Yang

2012

Journal of the Chinese Medical Association

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Cirrhosis is associated with hyperdynamic circulation, which consists of peripheral vasodilatation and increased cardiac output. Peripheral vasodilatation is central to hyperdynamic circulation and portal hypertension in cirrhosis. However, those mechanisms underlying hyperdynamic circulation remain elusive, and are not fully understood. Most of the earlier research and attention have been focused on humoral factor abnormalities. Various gut-derived or locally produced humoral factors such as nitric oxide, endotoxin, endocannabinoids, and others have been implicated as possible mediators of hyperdynamic circulation development in cirrhosis. The associated cardiac dysfunction had been termed "cirrhotic cardiomyopathy (CCM)," which is an entity different from that seen in alcoholic heart muscle disease. Clinically, these patients present with sodium fluid retention, and strain often unmasks the presence of latent heart failure. No specific treatment can yet be recommended, but caution should be used with respect to procedures that may stress the heart such as shunt implantation and liver transplantation. Ultimately, additional research will be necessary to more accurately describe the prevalence, impact, and morbidity and survival rates for CCM, and to identify potential treatments.

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Cardiac Dysfunction During Liver Transplantation: Incidence and Preoperative Predictors

Abstract: Abnormal cardiac response is observed during LT and may be a manifestation of occult cirrhotic cardiomyopathy. This finding is underestimated with usual diagnostic tools and could be related to indirect signs of circulatory dysfunction of advanced liver disease.

Cited by 78 publications

References 31 publications

Prospective Evaluation of Intraoperative Hemodynamics in Liver Transplantation with Whole, Partial and DCD Grafts

Prospective Evaluation of Intraoperative Hemodynamics in Liver Transplantation with Whole, Partial and DCD Grafts

Cirrhotic Cardiomyopathy

The heart: Pathophysiology and clinical implications of cirrhotic cardiomyopathy

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