Splanchnic and systemic circulation cross talks: Implications for hemodynamic management of liver transplant recipients

Mukhtar, Ahmed; Lotfy, Ahmed; Hussein, A.; Fouad, Eman

doi:10.1016/j.bpa.2019.12.003

Cited by 10 publications

(15 citation statements)

References 39 publications

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“…Intravenous fluid loading may result in an increased blood loss because of an increased portal venous pressure and an increased splanchnic venous congestion while providing minimal or no support for cardiac output. 21 In contrast, intravenous vasoconstrictors alter the splanchnic circulation and may decrease portal hyperemia and splanchnic venous congestion 12 , 13 besides supporting arterial blood pressure. In addition, a restrictive intravenous fluid volume management during the dissection phase was proven to minimize venous congestion and reduce blood loss.…”

Section: Discussionmentioning

confidence: 99%

“… 11 , 12 The cirrhotic liver causes a blood flow impediment in the portal vein and an increased secretion of compensatory vasoactive substances that increases splanchnic pooling. 12 , 13 The conventional strategy for optimizing cardiac output was limited to generous intravenous fluid administration (crystalloid, colloid, plasma)—to maintain arterial pressure and end-organ perfusion—during periods of caval compression and clamping. This approach has been increasingly questioned and replaced on the basis of our improved understanding of the physiology of end-stage liver disease.…”

Section: Introductionmentioning

confidence: 99%

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Association of Phlebotomy on Blood Product Transfusion Requirements During Liver Transplantation: An Observational Cohort Study on 1000 Cases

Massicotte

Hevesi

Zaouter

et al. 2022

Transplantation Direct

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Background. During the past 2 decades, transfusion requirements have decreased drastically during orthotopic liver transplantation (OLT), and transfusion-free transplantation is nowadays increasingly common. Understanding that liberal intravenous volume loading in cirrhotic patients may have detrimental consequences is key. In contrast, phlebotomy is a method to lower central venous pressure and portal venous pressure. The objective of this study was to determine the effectiveness and safety of phlebotomy in the early phase of blood transfusion, blood loss, renal function, and mortality. Methods. The present study evaluated the impact of phlebotomy on bleeding, transfusion rate, renal dysfunction, and mortality in 1000 consecutive OLTs. Two groups were defined and compared using phlebotomy. Multivariate logistic and linear regression models were used to determine predictors of bleeding, red blood cell (RBC) transfusion, renal dysfunction, and mortality. Results. A mean of 0.7 ± 1.5 RBC units was transfused per patient for 1000 OLTs, 75% did not receive any RBCs, and the median and interquartile range (25–75) were 0 for all blood products transfused. The phlebotomy was associated with decreased transfusion (RBCs, plasma, platelets, cryoprecipitate, albumin), with less bleeding, and with an increased survival rate, both 1 mo and 1 y. Phlebotomy was not associated with renal dysfunction. Conclusions. The practice of phlebotomy to lower portal venous pressure was associated with reduced blood product transfusions and blood loss during liver dissection without deleterious effect on renal function.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of Phlebotomy on Blood Product Transfusion Requirements During Liver Transplantation: An Observational Cohort Study on 1000 Cases

Massicotte

Hevesi

Zaouter

et al. 2022

Transplantation Direct

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“…1 E ´tant donne ´la relation physiologique entre la circulation splanchnique et syste ´mique, en particulier dans les maladies he ´patiques, deux approches pour prendre en charge le traitement du volume intravasculaire visant a `minimiser les saignements lors d'une transplantation he ´patique ont e ´te ´conceptualise ´es. 2 La premie `re vise une re ´duction du volume central et splanchnique par restriction volumique, avec ou sans phle ´botomie, afin de maintenir une pression veineuse centrale (PVC) basse puis de « re-remplir » la circulation apre `s la phase de reperfusion; la seconde a pour objectif la de ´congestion splanchnique a `l'aide de vasoconstricteurs. Dans la pratique clinique, les deux sont souvent combine ´es.…”

Section: Les E ´Tudes Observationnelles Ou La Que ˆTe Perpe ´Tuelle D...unclassified

“…1 Considering the physiologic relationship between the splanchnic and systemic circulation, particularly in liver disease, two approaches to manage intravascular volume therapy aimed at minimizing bleeding during liver transplantation have been conceptualized. 2 The first seeks a central and splanchnic volume reduction by volume restriction, with or without phlebotomy, to maintain low central venous pressure (CVP) and then ''refill'' the circulation after the reperfusion phase; the second aims for splanchnic decongestion using vasoconstrictors. In clinical practice, both are often used in combination.…”

mentioning

confidence: 99%

Observational studies: a perpetual quest for a signal among the noise

Valencia

2022

Can J Anesth/J Can Anesth

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“…The use of calcineurin inhibitors during the early postoperative hospital stay can result in the derangement of renal function, and contribute to this picture [11,12]. Moreover, the use of CRRT in the early postoperative period is also prompted by the need to avoid fluid overload, which seems to be a relevant cause of the increase in ischemia-reperfusion injury and can worsen the graft perfusion [13].…”

Section: Introductionmentioning

confidence: 99%

Continuous Renal Replacement Therapy after Liver Transplantation: Peri-Operative Associated Factors and Impact on Survival

Petri

Alduino

Volpes

et al. 2022

JCM

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Continuous renal replacement therapy (CRRT) following orthotopic liver transplantation (OLT) is usually started for multifactorial reasons, with variable incidence among series. This paper presents a single-center retrospective observational study on the early use (within one week) of CRRT after consecutive cadaveric OLT from January 2008 to December 2016. Preoperative patient characteristics and intraoperative data were collected, and patients were divided into two groups (CRRT and no CRRT) to explore the factors associated with the use of CRRT. Repeated measurements of postoperative creatinine were analyzed with generalized estimating equation (GEE) models. Among 528 OLT patients, 75 (14.2%) were treated with CRRT at least once in the first week. Patients treated with CRRT showed lower survival in a Kaplan–Meier curve (log-rank p value < 0.01). Patients treated with CRRT had a more severe preoperative profile, with a significantly higher age, MELD, BUN, creatinine, and total bilirubin, as well as a longer surgery time and a higher number of transfusions of red blood cells, plasma, and platelets (all p values < 0.05). In a stepwise multiple analysis, the following characteristics remained independently associated with the use of CRRT: the MELD score OR 1.12 (95% CL: 1.07–1.16), p value < 0.001, and the preoperative value for blood urea nitrogen OR 1.016 (95% CL: 1.010–1.023), p value < 0.001. The early use of CRRT after OLT occurred at a low rate in this large cohort; however, it was associated with worse outcomes. Apart from the preoperative severity, repeated intraoperative hypotension episodes, which were likely modifiable or preventable, were associated with the increased use of CRRT and higher postoperative creatinine.

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Splanchnic and systemic circulation cross talks: Implications for hemodynamic management of liver transplant recipients

Cited by 10 publications

References 39 publications

Association of Phlebotomy on Blood Product Transfusion Requirements During Liver Transplantation: An Observational Cohort Study on 1000 Cases

Association of Phlebotomy on Blood Product Transfusion Requirements During Liver Transplantation: An Observational Cohort Study on 1000 Cases

Observational studies: a perpetual quest for a signal among the noise

Continuous Renal Replacement Therapy after Liver Transplantation: Peri-Operative Associated Factors and Impact on Survival

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