Hori Tomohide, Ogura Yasuhiro, Onishi Yasuharu, Kamei Hideya, Kurata Nobuhiko, Kainuma Motoshi, Takahashi Hideo, Suzuki Shogo, Ichikawa Takashi, Mizuno Shoko, Aoyama Tadashi, Ishida Yuki, Hirai Takahiro, Hayashi Tomoko, Hasegawa Kazuko, Takeichi Hiromu, Ota Atsunobu, Kodera Yasuhiro, Sugimoto Hiroyuki, Iida Taku, Yagi Shintaro, Taniguchi Kentaro, Uemoto Shinji
Tomohide Hori, Yasuhiro Ogura, Yasuharu Onishi, Hideya Kamei, Nobuhiko Kurata, Department of Transplant Surgery, Nagoya University Hospital, Nagoya 466-8550, Japan.
World J Hepatol. 2016 Sep 8;8(25):1047-60. doi: 10.4254/wjh.v8.i25.1047.
Advanced liver cirrhosis is usually accompanied by portal hypertension. Long-term portal hypertension results in various vascular alterations. The systemic hemodynamic state in patients with cirrhosis is termed a hyperdynamic state. This peculiar hemodynamic state is characterized by an expanded blood volume, high cardiac output, and low total peripheral resistance. Vascular alterations do not disappear even long after liver transplantation (LT), and recipients with cirrhosis exhibit a persistent systemic hyperdynamic state even after LT. Stability of optimal systemic hemodynamics is indispensable for adequate portal venous flow (PVF) and successful LT, and reliable parameters for optimal systemic hemodynamics and adequate PVF are required. Even a subtle disorder in systemic hemodynamics is precisely indicated by the balance between cardiac output and blood volume. The indocyanine green (ICG) kinetics reflect the patient's functional hepatocytes and effective PVF, and PVF is a major determinant of the ICG elimination constant (kICG) in the well-preserved allograft. The kICG value is useful to set the optimal PVF during living-donor LT and to evaluate adequate PVF after LT. Perioperative management has a large influence on the postoperative course and outcome; therefore, key points and unexpected pitfalls for intensive management are herein summarized. Transplant physicians should fully understand the peculiar systemic hemodynamic behavior in LT recipients with cirrhosis and recognize the critical importance of PVF after LT.
晚期肝硬化通常伴有门静脉高压。长期门静脉高压会导致各种血管改变。肝硬化患者的全身血流动力学状态被称为高动力状态。这种特殊的血流动力学状态的特征是血容量增加、心输出量高和总外周阻力低。即使在肝移植（LT）后很长时间，血管改变也不会消失，肝硬化受者即使在LT后仍表现出持续的全身高动力状态。最佳全身血流动力学的稳定性对于充足的门静脉血流（PVF）和成功的LT是必不可少的，并且需要用于最佳全身血流动力学和充足PVF的可靠参数。心输出量和血容量之间的平衡精确地表明了全身血流动力学中即使是细微的紊乱。吲哚菁绿（ICG）动力学反映了患者的功能性肝细胞和有效的PVF，并且PVF是保存良好的同种异体移植物中ICG消除常数（kICG）的主要决定因素。kICG值有助于在活体供肝LT期间设定最佳PVF，并评估LT后的充足PVF。围手术期管理对术后病程和结果有很大影响；因此，本文总结了强化管理的关键点和意外陷阱。移植医生应充分了解肝硬化LT受者特殊的全身血流动力学行为，并认识到LT后门静脉血流的至关重要性。
