Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 8, 2015; 7(10): 1302-1311
Published online Jun 8, 2015. doi: 10.4254/wjh.v7.i10.1302
Hemodynamic monitoring during liver transplantation: A state of the art review
Mona Rezai Rudnick, Lorenzo De Marchi, Jeffrey S Plotkin
Mona Rezai Rudnick, Lorenzo De Marchi, Jeffrey S Plotkin, Department of Anesthesiology, Georgetown University Hospital, NW Washington, DC 20007, United States
Author contributions: De Marchi L and Plotkin JS designed research; Rudnick MR performed research; Rudnick MR and Plotkin JS analyzed data; Rudnick MR wrote the paper.
Conflict-of-interest: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jeffrey S Plotkin, MD, Department of Anesthesiology, Georgetown University Hospital, CCC Building Lower Level Rm CL-60, 3800 Reservoir Road, NW Washington, DC 20007, United States. plotkinj@gunet.georgetown.edu
Telephone: +1-202-4448640 Fax: +1-202-4448854
Received: September 19, 2014
Peer-review started: September 20, 2014
First decision: December 17, 2014
Revised: March 25, 2015
Accepted: April 8, 2015
Article in press: April 9, 2015
Published online: June 8, 2015
Abstract

Orthotopic liver transplantation can be marked by significant hemodynamic instability requiring the use of a variety of hemodynamic monitors to aide in intraoperative management. Invasive blood pressure monitoring is essential, but the accuracy of peripheral readings in comparison to central measurements has been questioned. When discrepancies exist, central mean arterial pressure, usually measured at the femoral artery, is considered more indicative of adequate perfusion than those measured peripherally. The traditional pulmonary artery catheter is less frequently used due to its invasive nature and known limitations in measuring preload but still plays an important role in measuring cardiac output (CO) when required and in the management of portopulmonary hypertension. Pulse wave analysis is a newer technology that uses computer algorithms to calculate CO, stroke volume variation (SVV) and pulse pressure variation (PPV). Although SVV and PPV have been found to be accurate predicators of fluid responsiveness, CO measurements are not reliable during liver transplantation. Transesophageal echocardiography is finding an increasing role in the real-time monitoring of preload status, cardiac contractility and the diagnosis of a variety of pathologies. It is limited by the expertise required, limited transgastric views during key portions of the operation, the potential for esophageal varix rupture and difficulty in obtaining quantitative measures of CO in the absence of tricuspid regurgitation.

Keywords: Intraoperative monitoring, Physiologic monitoring, Liver transplantation

Core tip: Accurate hemodynamic monitoring is essential to safely navigate orthotopic liver transplantation. Although specific indications for pulmonary artery catheters exist, their use has slowly been replaced by newer technologies which offer less invasive and more accurate measurement. The latest evidence on the strengths and limitations of arterial pulse wave form analysis, intraoperative transesophageal echocardiography, peripheral vs central arterial blood pressure monitoring and pulmonary arterial catheters are discussed.