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Tsung-Hsiao Shih, Chia-Jung Huang, Chao-Long Chen, Kwok-Wai Cheng, Shao-Chun Wu, Sheng-Chun Yang, Sin-Ei Juang, Ying-En Lee, Bruno Jawan, Chih-Hsien Wang
(Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kaohsiung, Taiwan)
Ann Transplant 2015; 20:519-525
The aim of this study was to evaluate the impact of different methods of inferior vena cava (IVC) clamping and release of the cross clamp on hemodynamic parameters of recipients during living donor liver transplantation.
MATERIAL AND METHODS: Ninety-six adult living donor liver transplantation patients were divided into 3 groups according to cross-clamp of the IVC for all the hepatic vein and portal vein reconstruction (G1), cross-clamp of the IVC only for hepatic vein reconstruction (G2), and side-clamp of the IVC for hepatic vein reconstruction (G3). In G2 and G2, the reconstructed hepatic vein was clamped instead of the IVC for portal vein reconstruction. The hemodynamic parameters among groups were compared by 1-way ANOVA and the complications in each group were compared using the Kruskal-Wallis test.
RESULTS: Changes in percentage of MAP and CO in G3 were significantly less than that of G1 and G2 for hepatic vein reconstruction. Hemodynamic parameters of G2 and G3 normalized to pre-clamped values during portal vein reconstruction, while the hemodynamics of G1 remained unstable.
CONCLUSIONS: Hemodynamic changes were less pronounced in LT with side-clamp of the inferior cava vein versus total cross-clamp. Early release of the IVC clamp minimized the hemodynamic changes. There were no differences in terms of outcome (morbidity and mortality).
Keywords: Hemodynamics, Liver Transplantation, Monitoring, Intraoperative