Clinical Research
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 28, 2007; 13(44): 5918-5925
Published online Nov 28, 2007. doi: 10.3748/wjg.v13.i44.5918
Stability of cirrhotic systemic hemodynamics ensures sufficient splanchnic blood flow after living-donor liver transplantation in adult recipients with liver cirrhosis
Tomohide Hori, Shintaro Yagi, Taku Iida, Kentaro Taniguchi, Kentaro Yamagiwa, Chiduru Yamamoto, Takashi Hasegawa, Koichiro Yamakado, Takuma Kato, Kanako Saito, Linan Wang, Mie Torii, Yukinobu Hori, Kan Takeda, Kazuo Maruyama, Shinji Uemoto
Tomohide Hori, Kentaro Taniguchi, Kentaro Yamagiwa, Chiduru Yamamoto, Departments of Hepatobiliary Pancreatic Surgery, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan
Takuma Kato, Linan Wang, Mie Torii, Department of Cellular and Molecular Immunology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan
Shintaro Yagi, Taku Iida, Shinji Uemoto, Department of Hepatobiliary Pancreatic and Transplant Surgery, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
Takashi Hasegawa, Kazuo Maruyama, Department of Anesthesiology and Critical Care Medicine, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan
Koichiro Yamakado, Kan Takeda, Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan
Kanako Saito, Department of Medical Oncology and Immunology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan
Yukinobu Hori, Nagoya Economic University Graduate School of Law, 61-1 Uchikubo, Inuyama City, Aichi Prefecture, 484-8504, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Tomohide Hori, Department of Hepato-biliary Pancreatic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture, 514-8507, Japan. tomohide@clin.medic.mie-u.ac.jp
Telephone: +81-59-2321111 Fax: +81-59-2328095
Received: June 18, 2007
Revised: August 15, 2007
Accepted: October 17, 2007
Published online: November 28, 2007
Abstract

AIM: To investigate the correlation between systemic hemodynamics and splanchnic circulation in recipients with cirrhosis undergoing living-donor liver transplantation (LDLT), and to clarify how systemic hemodynamics impact on local graft circulation after LDLT.

METHODS: Systemic hemodynamics, indocyanine green (ICG) elimination rate (KICG) and splanchnic circulation were simultaneously and non-invasively investigated by pulse dye densitometry (PDD) and ultrasound. Accurate estimators of optimal systemic hyperdynamics after LDLT [i.e., balance of cardiac output (CO) to blood volume (BV) and mean transit time (MTT), defined as the time required for half the administered ICG to pass through an attached PDD sensor in the first circulation] were also measured. Thirty recipients with cirrhosis were divided into two groups based on clinical outcomes corresponding to postoperative graft function.

RESULTS: Cirrhotic systemic hyperdynamics characterized by high CO, expanded BV and low total peripheral resistance (TPR) were observed before LDLT. TPR reflecting cirrhotic vascular alterations was slowly restored after LDLT in both groups. Although no significant temporal differences in TPR were detected between the two groups, CO/BV and MTT differed significantly. Recipients with good outcomes showed persistent cirrhotic systemic hyperdynamics after LDLT, whereas recipients with poor outcomes presented with unstable cirrhotic systemic hyperdynamics and severely decreased KICG. Systemic hyperdynamic disorders after LDLT impacted on portal venous flow but not hepatic arterial flow.

CONCLUSION: We conclude that subtle systemic hyperdynamics disorders impact on splanchnic circulation, and that an imbalance between CO and BV decreases portal venous flow, which results in critical outcomes.

Keywords: Cirrhosis, Hyperdynamic, Portal hypertension, Splanchnic, Indocyanine green