Hemodynamic and Metabolic Changes during Orthotopic Liver Transplantation in Dogs

Moon, Jong Seon; Lee, Chang Jun; Shin, Keun Man; Hong, Soon Yong; Choi, Young Ryong; Lee, Young Joo

Abstract

Skilled and experienced anestheia is of great importance for patients undergoing orthotopic liver transplantation, because of multiple preexisting medical problems in such patients as well as the intraoperative problems of rapid hemodynamic, metabolic, and coagulation changes. In this study, the intraoperative hemodynamic and laboratory data were analyzed in ten dogs that underwent an orthotopic liver transplantation procedure by veno-venous bypass using Biopump. Liver transplantation can be divided into three distinct periods: stage I, or preanhepatic stage, which begins with the induction of anesthesia and continues until cross clamping of portal vein and IVC; stage II, or anhepatic stage, which begins at the anhepatic time and continues until the donor liver is reperfused by the recipients circulating blood; and stage III, or postanhepatic stage, which begins at the time of reperfusion and continues until the end of surgical procedure. The hemodynamic changes at the time of IVC and portal vein cross clamping were decreases in CVP, PCWP, and pulmonary artery pressure in spite of using Biopump. The significant metabolic alternations during anhepatic stage were decrease in blood glucose levels and increase in blood lactate levels. The more significant hemodynamic changes occurred at the time of reperfusion. Systolic pressure decreased suddenly to 58+/-6 mmHg and cardiac output decreased to 1.08+/-0.1l L/min. However heart rate, pulmonary artery pressure, CVP, and PCWP did not change significantly. During stage III, hyperglycemia occurred quite frequently. Significant abnormal coagulation chages could not be found, probably because the dogs were healthy. In conclusion, during anhepatic stage, we have to compensate for alternations of fluid balance. At the time of reperfusion, we should prevent severe hemodynamic changes and treat them immediately if they occur. However, it seems that glucose administration is not necessary to the liver recipient during stage II because there is no significant hemodynamic depression due to hypoglycemia at this time and hyperglycemia occurs later.