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

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 (K ICG) 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 K ICG. 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.

Figure 1

Survival rates after LDLT. The two lines represent the survival rates for Groups I and II. The P value analyzed by the log-rank test was < 0.0001.

Figure 2

Temporal changes in systemic hemodynamic parameters before and after LDLT. A: Temporal changes in the ratio of CO to BV before and after LDLT; B: Temporal changes in MTT before and after LDLT; C: Temporal changes in TPR before and after LDLT. Open and closed circles represent systemic hemodynamic parameters for Groups I and II, respectively. Shaded areas show normal ranges measured in healthy individuals.

Figure 3

Temporal changes in K_ICG before and after LDLT. Open and closed circles represent K_ICG values for Groups I and II, respectively. The shaded area shows the normal range measured in healthy individuals.

Figure 4

Temporal changes in splanchnic circulatory parameters before and after LDLT. A: Temporal changes in PVFVo before and after LDLT; B: Temporal changes in PVFVe before and after LDLT. Open and closed circles represent splanchnic circulatory parameters for Groups I and II, respectively. Shaded areas show normal ranges measured in healthy individuals.