成人活体肝移植术后成功临床结局的最佳全身血流动力学稳定性：前瞻性观察研究。

Optimal systemic hemodynamic stability for successful clinical outcomes after adult living-donor liver transplantation: prospective observational study.

作者信息

Hori Tomohide, Yagi Shintaro, Iida Taku, Taniguchi Kentaro, Yamagiwa Kentaro, Yamamoto Chiduru, Hasegawa Takashi, Yamakado Koichiro, Kato Takuma, Saito Kanako, Wang Linan, Torii Mie, Hori Yukinobu, Takeda Kan, Maruyama Kazuo, Uemoto Shinji

机构信息

Department of Hepato-pancreato-biliary Surgery and Transplantation, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan.

出版信息

J Gastroenterol Hepatol. 2008 Jul;23(7 Pt 2):e170-8. doi: 10.1111/j.1440-1746.2008.05394.x. Epub 2008 Apr 19.

DOI:10.1111/j.1440-1746.2008.05394.x

PMID:18422962

Abstract

BACKGROUND AND AIM

Most living-donor liver transplantation (LDLT) recipients show characteristic systemic hemodynamics due to liver cirrhosis, and systemic hemodynamics after LDLT influenced postoperative graft function corresponding to outcomes. However, identities of optimal systemic hemodynamics for excellent outcomes and precise parameters for clinical strategy remain unclear.

METHODS

Therefore, we performed prospective study in adult LDLT recipients from 2003. Hemodynamic parameters were prospectively recorded, and were analyzed in 40 recipients classified into three groups: cirrhotic (group I-C) or non-cirrhotic recipients (group I-NC) with good outcomes, and cirrhotic recipients (group II-C) without good outcomes.

RESULTS

Group I-C retained characteristic hyperdynamics even after LDLT. However, absolute values of parameters revealed no significant differences between groups I-C and II-C, because group II-C also tended to show hyperdynamics. It is suggested that successful outcomes in cirrhotic recipients require maintenance of optimal hyperdynamic stability after LDLT, because cirrhotic vascular alterations still occurred. Because hemodynamic behaviors were different between groups I-C and I-NC, absolute values were also significantly different even in these successful two groups. Thus, absolute values themselves were not necessarily satisfactory for accurate evaluation of optimal hemodynamic stability. Cirrhotic hyperdynamics are symbolized in large blood volume (BV) circulated by high cardiac output (CO); therefore, we standardized CO against BV. CO/BV was significantly different between groups I-C and II-C, reflecting subtle variability of hyperdynamics in groups II-C, and was interestingly constant in the two successful groups. Therefore, CO/BV reliably evaluated optimal hemodynamic stability after LDLT, and accurately predicted outcomes.

CONCLUSION

Identification of inappropriate hemodynamics after LDLT is advantageous to further improve LDLT outcomes.

摘要

背景与目的

大多数活体肝移植（LDLT）受者因肝硬化呈现出特征性的全身血流动力学变化，而LDLT后的全身血流动力学影响术后移植物功能及相应结局。然而，对于良好结局的最佳全身血流动力学特征及临床策略的精确参数仍不明确。

方法

因此，我们自2003年起对成年LDLT受者进行了前瞻性研究。前瞻性记录血流动力学参数，并对40例受者进行分析，分为三组：结局良好的肝硬化受者（I-C组）或非肝硬化受者（I-NC组），以及结局不佳的肝硬化受者（II-C组）。

结果

I-C组即使在LDLT后仍保持特征性的高动力状态。然而，参数的绝对值在I-C组和II-C组之间无显著差异，因为II-C组也倾向于表现出高动力状态。提示肝硬化受者获得成功结局需要在LDLT后维持最佳的高动力稳定性，因为肝硬化血管改变仍会发生。由于I-C组和I-NC组的血流动力学表现不同，即使在这两组成功的受者中绝对值也存在显著差异。因此，绝对值本身不一定能准确评估最佳血流动力学稳定性。肝硬化高动力状态表现为高心输出量（CO）循环的大量血容量（BV）；因此，我们用CO除以BV进行标准化。I-C组和II-C组之间的CO/BV有显著差异，反映了II-C组高动力状态的细微变化，有趣的是，在两组成功的受者中该值保持恒定。因此，CO/BV可靠地评估了LDLT后的最佳血流动力学稳定性，并准确预测了结局。