Low values of left ventricular ejection time in the post-anhepatic phase may be associated with occurrence of primary graft dysfunction after orthotopic liver transplantation: results of a single-centre case-control study

Abstract. – BACKGROUND: Previous investi- gations on risk factors for orthotopic liver trans- plantation (OLT) surgery have not analyzed he- modynamic aberrations in great detail. Moreover, the usefulness of esophageal Doppler monitor- ing has not been extensively studied in this clini- cal setting. The aim of this study was to evaluate if the occurrence of primary graft dysfunction (PGD) may be anticipated by hemodynamic in- dexes measured by esophageal Doppler (ED) monitoring system as well as by pulmonary artery catheter (PAC) in patients undergoing OLT. MATERIALS AND METHODS: 38 OLT recipi- ents were studied. Patients with acute liver fail- ure or having non treated esophageal varices and those transplanted with marginal donors were excluded from the study. The haemodynam- ic data – measured by ED monitoring system (HemosonicTM 100, Arrow, OK, USA) and PAC – collected at the following 3 time points were considered for statistical analysis: 30 minutes after the induction of anesthesia but before skin incision, T0; 20 minutes after liver dissection, T1; at the beginning of biliary reconstruction, T2. On the basis of early outcome (72 hours after OLT), patients were distinguished into two groups: those with PGD (grade III-IV of Toronto classifi- cation) and those without PGD (grade I-II). RESULTS: LVETc (left ventricular ejection time) values, registered at the beginning of biliary re- construction (T2), were lower in patients with PGD compared to those without PGD (p < 0.000), while there were no differences in hemodynamic para- meters derived from PAC between the two groups. CONCLUSIONS: Since LVETc is related to pre- load, the results of this study would suggest that normovolemia could be the end point of a fluid replacement strategy in OLT setting.