The Relationship between Whole Body Oxygen Delivery and Oxygen Consumption in Anhepatic Phase of Canine Liver Transplantation

Kang, Ki Chul; Lee, Kook Hyun

Abstract

BACKGROUND: In patients of sepsis, especially combined with multiple organ failure syndrome, the whole body oxygen consumption is delivery dependent even above the critical oxgen delivery. This phenomenon is named as 'pathologic oxygen delivery dependency'. Multiple organ failure syndrome is characterized by maldistribution of oxygen delivery, tissue oxygen diffusion disturbance and inability of oxidative phosphorylation of anaerobic metabolites owing to hepatic failure. In liver transplantation, the anhepatic phase is characterized by uneven microperfusion due to surgical manipulation and 'total hepatic failure'. We hypothesized that there might be oxygen delivery dependency in anhepatic phase of liver transplantation.
METHODS
In 14 canine orthotopic liver transplantations, whole body oxygen delivery (DO2) and oxygen consumption (VO2) were calculated as the product of cardiac output and, arterial oxygen content and arterial-venous oxygen content difference, respectively, according to the operative phases. Then the relationship between DO2 and VO2 was analyzed by correlation analysis in each operative phases.
RESULTS
In control and four reperfusion phases no significant correlation was found. But in two anhepatic phases (10 minutes after inferior vena cava cross clamping, 5 minutes before reperfusion), significant correlation was found (R=0.79, 0.72, p<0.005, 0.01 repectively). In postinduction phase (50 minutes after induction), significant correlation was found (R=0.62, p<0.05), but strength of correlation was lower.
CONCLUSIONS
This study showed the oxygen delivery dependency in anhepatic phase of liver transplantation. Therefore supranormal oxygen supply advocated in multiple organ failure syndrome and sepsis might be applicable to management of anhepatic phase of selected recipients.