Is Hepatic Flow a Predictor of Early Allograft Dysfunction in Whole-Graft Deceased Donor Liver Transplantation? An Observational Cohort Study.
Pablo Lozano1, Maitane Orue Echebarria1, José Manuel Asencio1, Luis Olmedilla1, María Magdalena Salcedo1, Hemant Sharma2, Enrique Velasco1, Colon Arturo1, Bachiller Luis1, Benjamín Díaz-Zorita1, José Angel López Baena1.
1Liver transplant Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain; 2Organ transplantation Unit , Ochsner Medical Center, New Orleans, LA, United States
Background: Early allograft dysfunction (EAD) is an important cause of morbidity and mortality in patients undergoing liver transplantation. Liver perfusion is an important issue to ensure the synthetic function of the graft. We propose the measurement of intraoperative portal venous and hepatic artery flow as a predictors of EAD.
Aim: To demonstrate that intraoperative liver flow is a predictor of EAD in whole-graft decease donor liver transplantation.
Materials and Methods: We propose an observational study of a single patient cohort (n = 195). It was carried out in the study period between January 2008 and December 2014. The measurement of the intraoperative flows was made with a VeriQ flow meter. EAD was defined according to Olthoff criteria. Unless otherwise stated, data were expressed as mean (SD, standard deviation) or n (%). When data were normally distributed (based on the Kolmogorov-Smirnov test) they were compared using the t-Student test. The qualitative variables and risk measurement was analyzed using the chi-square test. The univariate and multivariate analysis of graft dysfunction was held by a logistic regression test. Predictive analysis was evaluated using ROC curves (Receiver Operating Characteristic).
Results: 71 patients (31%) developed EAD. Mean survival of the group with EAD was 54.2 months (95% CI: 45.04-63.29) and the group non-EAD was 69.17 months (95% CI: 64, 11-74, 22) (p <0.01). Portal flow showed significant differences in the development of EAD (EAD Group: 1,363.84 ± 602.06 ml / min versus Non-EAD Group: 1,606.73 ± 491.51 ml / min, p = 0, 01) The univariate analysis showed that arterial flow, portal flow, cold ischemia time, and the need for intraoperative fibrinogen were associated with EAD (p <0.05). Multivariate analysis portal flow, hepatic artery flow and cold ischemia time showed association with EAD (p <0.01).
Conclusion: Intraoperative test of hepatic hemodynamics could predict EAD early in the intraoperative time. Modulation of abnormalities in portal flow in whole-graft liver donor could be a proposed strategy to avid the development of EAD
