Stability of cirrhotic systemic hemodynamics ensures sufficient splanchnic blood flow after living-donor liver transplantation in adult recipients with liver cirrhosis

Table 1 Systemic hemodynamic parameters, K_ICG values and splanchnic circulatory parameters before LDLT

Parameters	Healthy individuals n = 16	Group I n = 25	Group II n = 5
Systemic hemodynamics
CO (L/min)	5.83 ± 1.52	6.87 ± 0.97a	7.36 ± 1.07e
CI (L/min per m2)	3.22 ± 0.71	4.10 ± 0.71b	4.56 ± 0.58e
BV (L)	3.40 ± 0.96	4.09 ± 0.51a	4.40 ± 0.45e
CO/BV (/min)	1.74 ± 0.28	1.69 ± 0.21	1.69 ± 0.28
MTT (s)	16.1 ± 2.3	16.5 ± 1.5	16.5 ± 1.2
HR (beat/min)	64.3 ± 9.9	77.9 ± 12.6b	77.6 ± 9.8e
MAP (mmHg)	89.3 ± 11.8	68.9 ± 6.5d	70.8 ± 11.2e
TPR (dyne/s5 per cm)	1275.1 ± 228.3	818.9 ± 166.7d	785.3 ± 187.4e
ICG clearance test
KICG	0.227 ± 0.076	0.037 ± 0.017d	0.056 ± 0.038e
Splanchnic circulation
Portal vein
PVFVo (mL/min)	1482.1 ± 335.6	327.3 ± 416.9d	435.6 ± 592.6e
PVFVe (cm/s)	45.1 ± 8.1	7.9 ± 12.8d	10.5 ± 13.8f
Hepatic artery
HAPI	0.95 ± 0.11	1.06 ± 0.28a	1.16 ± 0.21e
HARI	0.93 ± 0.26	1.04 ± 0.23a	1.10 ± 0.10e

There were no significant differences between Groups I and II in each parameter, respectively (P > 0.05, analyzed by Mann-Whitney’s U test ). Statistical differences between healthy individuals and Group I analyzed by Mann-Whitney’s U test (^aP < 0.05,

^bP < 0.005,

^dP < 0.0005). Statistical differences between healthy individuals and Group II analyzed by Mann-Whitney’s U test (^eP < 0.05,

^fP < 0.005). ICG: Indocyanine green; LDLT: Living-donor liver transplantation; CO: Cardiac output; CI: Cardiac index; BV: Blood volume; MTT: Mean transit time; HR: Heart rate; MAP: Mean arterial pressure; TPR: Total peripheral resistance; PVFVo: Portal veinous flow volume; PVFVe: Portal venous flow velocity; HAPI: Hepatic arterial pulsatility index; HARI: Hepatic arterial resistant index.

Table 2 Clinical profiles before, during and after LDLT

Clinical profile	Group I(n = 25)	Group II(n = 5)	P valuea
Before LDLT
Age	51.8 ± 9.8	58.6 ± 3.5	NS
Body surface area (m2)	1.69 ± 0.18	1.61 ± 0.12	NS
Child-Pugh score (points)	9.2 ± 2.3	10.8 ± 2.2	NS
Model for end-stage liver disease score (points)	17.6 ± 6.7	17.4 ± 7.1	NS
During LDLT
Native liver weight (g)	857.0 ± 227.5	946.0 ± 376.2	NS
Portal venous pressure before removal of native liver (mmHg)	21.5 ± 4.7	24.6 ± 7.1	NS
Cold ischemic time (min)	163.7 ± 79.0	139.6 ± 52.6	NS
Warm ischemic time (min)	55.1 ± 16.7	45.8 ± 12.7	NS
Anhepatic phase (min)	209.2 ± 104.9	184.4 ± 177.6	NS
Operative time (min)	899.4 ± 126.7	933.4 ± 131.0	NS
Blood loss (mL)	22515.7 ± 14200.5	22788.6 ± 19247.8	NS
Graft weight (g)	687.8 ± 124.6	632.0 ± 72.9	NS
Graft-recipient weight ratio	1.09 ± 0.21	1.23 ± 0.37	NS
After LDLT
Intensive care unit stay (d)	5.1 ± 1.9	35.6 ± 15.7	< 0.005
%SLV based on CT volumetry
2 wk after LDLT	1.14 ± 0.22	1.07 ± 0.09	NS
4 wk after LDLT	1.05 ± 0.15	1.17 ± 0.16	NS
LHL15 based on 99mTc-GSA liver scintigraphy
2 wk after LDLT	0.935 ± 0.026	0.846 ± 0.061	< 0.005
4 wk after LDLT	0.941 ± 0.017	0.751 ± 0.034	< 0.005
Histopathological fraft parenchymal damage score (points)
Within 4 wk after LDLT	3.9 ± 1.4	10.6 ± 1.3	< 0.005

Statistical differences between Groups I and II analyzed by Mann-Whitney’s U test (NS: P > 0.05). LDLT: Living-donor liver transplantation; SLV: Standard liver volume; CT: Computed tomographic; LHL15: The ratio of liver to heart-plus-liver radioactivity at 15 min; 99mTc-GSA: Technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl-human serum albumin.

Table 3 Statistical differences in post-operative temporal changes of systemic hemodynamic parameters, K_ICG values and splanchnic circulatory parameters

Parameters	Statistical temporal differences after LDLT between Groups I and II P value1
Systemic hemodynamics
CO (L/min)	0.2321
CI (L/min per m2)	0.5037
BV (L)	0.3420
CO/BV (/min)	0.0426a
MTT (s)	0.0023b
HR (beat/min)	0.0701
MAP (mmHg)	0.2453
TPR (dyne/s5 per cm)	0.8859
ICG clearance test
KICG	0.0001d
Splanchnic circulation
Portal vein
PVFVo (mL/min)	0.0113a
PVFVe (cm/s)	0.0171a
Hepatic artery
HAPI	0.2504
HARI	0.4261

¹Statistical temporal differences between Groups I and II analyzed by repeated measures ANOVA (^aP < 0.05,

^bP < 0.005,

^dP < 0.0005). ICG: Indocyanine green; LDLT: Living-donor liver transplantation; CO: Cardiac output; CI: Cardiac index; BV: Blood volume; MTT: Mean transit time; HR: Heart rate; MAP: Mean arterial pressure; TPR: Total peripheral resistance; PVFVo: Portal veinous flow volume; PVFVe: Portal venous flow velocity; HAPI: Hepatic arterial pulsatility index; HARI: Hepatic arterial resistant index.