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World J Gastroenterol. Aug 28, 2014; 20(32): 11131-11141
Published online Aug 28, 2014. doi: 10.3748/wjg.v20.i32.11131
Hepatic hemodynamic changes during liver transplantation: A review
An-Chieh Feng, Hsiu-Lung Fan, Teng-Wei Chen, Chung-Bao Hsieh
An-Chieh Feng, Hsiu-Lung Fan, Teng-Wei Chen, Chung-Bao Hsieh, Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Neihu, Taipei 11490, Taiwan
Author contributions: Feng AC, Hsieh CB, Fan HL and Chen TW performed the research; Feng AC and Hsieh CB wrote the paper.
Correspondence to: Chung-Bao Hsieh, MD, Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Cheng-Kung Rd, Sec2, Neihu, Taipei 11490, Taiwan. albert0920@yahoo.com.tw
Telephone: +886-9-33980018 Fax: +886-2-87927372
Received: January 3, 2014
Revised: March 21, 2014
Accepted: April 30, 2014
Published online: August 28, 2014
Processing time: 237 Days and 17.7 Hours
Abstract

Liver transplantation is performed in the recent decades with great improvements not only technically but also conceptually. However, there is still lack of consensus about the optimal hemodynamic characteristics during liver transplantation. The representative hemodynamic parameters include portal vein pressure, portal vein flow, and hepatic venous pressure gradient; however, there are still others potential valuable parameters, such as total liver inflow and hepatic artery flow. All the parameters are correlated closely and some internal modulating mechanisms, like hepatic arterial buffer response, occur to maintain stable hepatic inflow. To distinguish the unique importance of each hepatic and systemic parameter in different states during liver transplantation, we reviewed the published data and also conducted two transplant cases with different surgical strategies applied to achieve ideal portal inflow and pressure.

Keywords: Liver transplantation; Hemodynamics; Graft inflow modulation; Liver circulation; Small-for-size syndrome

Core tip: Even with the technical advancement of liver transplantation, there is still lack of consensus about the optimal range of the hepatic hemodynamic parameters intra-operatively. In this article, we review the physiology of liver hemodynamics in the normal population and also in the cirrhosis-related portal hypertension. The hemodynamic changes during liver transplantation with different graft types according to the primary hepatic circulation of the recipients are discussed. Finally, the flowchart applied in our center for performing graft inflow modulation according to systemic and hepatic hemodynamic parameters during liver transplantation is proposed in detail.