• Yoshihisa Morita, Taro Kariya, Shunji Nagai, Ahmad Itani, Michael Isley, and Kenichi Tanaka.
• Department of Anesthesiology, University of Maryland, Baltimore, MD. Electronic address: ymorita@som.umaryland.edu.
• J. Cardiothorac. Vasc. Anesth. 2021 Nov 1; 35 (11): 3275-3282.

ObjectivesThe authors devised a hepatic vein flow index (HVFi), using intraoperative transesophageal echocardiography and graft weight, and investigated its predictive value for postoperative graft function in orthotopic liver transplant.DesignProspective clinical trial.Setting,Single-center tertiary academic hospital.ParticipantsNinety-seven patients who had orthotopic liver transplant with the piggy-back technique between February 2018 and December 2019.Measurements And Main ResultsHVFi was defined with HV flow/graft weight. Patients who developed early graft dysfunction (EAD) had low HVFi in systole (HVFi sys, 1.23 v 2.19 L/min/kg, p < 0.01), low HVFi in diastole (HVFi dia, 0.87 v 1.54 L/min/kg, p < 0.01), low hepatic vein flow (HVF) in systole (HVF sys, 2.04 v 3.95 L/min, p < 0.01), and low HVF in diastole (HVF dia, 1.44 v 2.63 L/min, p < 0.01). More cardiac death, more vasopressors at the time of measurement, more acute rejection, longer time to normalize total bilirubin (TIME t-bil), longer surgery time, longer neohepatic time, and more packed red blood cell transfusion were observed in the EAD patients. All HVF parameters were negatively correlated with TIME t-bil (HVFi sys R = -0.406, p < 0.01; HFVi dia R = -0.442, p < 0.01; HVF sys R = -0.44, p < 0.01; HVF dia R = -0.467, p < 0.01). The receiver operating characteristic curve analysis determined the best cut-off levels of HVFi to predict occurrence of EAD (HVFi sys <1.608, HVFi dia <0.784 L/min/kg), acute rejection (HVFi sys <1.388, HVFi dia <1.077 L/min/kg), and prolonged high total bilirubin (HVFi sys <1.471, HVFi dia <1.087 L/min/kg).ConclusionsThe authors' devised HVFi has the potential to predict the postoperative graft function.Copyright © 2021 Elsevier Inc. All rights reserved.

13 keywords...

hide…