Hemodynamics during liver transplantation: The interactions between cardiac output and portal venous and hepatic arterial flows

• Published in: Hepatology (Baltimore, Md.) Md.), 1992-09, Vol.16 (3), p.715-718
• Main Authors: Henderson, J. Michael, Gilmore, G. Thomas, Mackay, Gregory J., Galloway, John R., Dodson, Thomas F., Kutner, Michael H.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Blood Pressure - physiology; Cardiac Output - physiology; Hepatic Artery - physiology; Humans; Liver Circulation - physiology; Liver Diseases - physiopathology; Liver Diseases - surgery; Liver Transplantation - physiology; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Portal Vein - physiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Venous Pressure - physiology
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.1840160316

Liver blood flow and systemic hemodynamics were measured intraoperatively in 34 patients after liver transplantation. Ultrasound transit‐time flow probes measured hepatic arterial and portal venous flow over 10 to 75 min 1 to 3 hr after reperfusion. Cardiac output was measured by thermodilution. Mean cardiac output was 9.5 ± 2.8 L/min; the mean total liver blood flow of 2,091 ± 932 ml/min was 23% ± 11% of cardiac output. Mean portal flow of 1,808 ± 929 ml/min was disproportionately high at 85% ± 10% of total liver blood flow. Correlation analysis showed a significant (p < 0.01; r = 0.42) correlation between cardiac output and portal venous flow and a trend toward negative correlation (p = 0.087) between cardiac output and hepatic arterial flow. These data show that increased flow in the newly transplanted liver is predominantly portal venous flow and is associated with high cardiac output and reduced hepatic arterial flow. In the last 13 patients studied, portal flow was reduced by 50% and the hepatic artery response was measured. We saw a significant (p < 0.05) increase in hepatic artery flow from 322 ± 228 to 419 ± 271 ml/min, indicating an intact hepatic arterial buffer response. The hepatic artery response also showed that it is a reversible rather than a fixed resistance that contributes to the low hepatic artery flow in these patients. (HEPATOLOGY 1992;16:715–718.)