Department of Anesthesiology, University of Maryland, Baltimore, MD.
Department of Anesthesiology, University of Tokyo, Tokyo, Japan.
J Cardiothorac Vasc Anesth. 2021 Nov;35(11):3275-3282. doi: 10.1053/j.jvca.2020.12.034. Epub 2020 Dec 24.
The 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.
Prospective clinical trial.
SETTING,: Single-center tertiary academic hospital.
Ninety-seven patients who had orthotopic liver transplant with the piggy-back technique between February 2018 and December 2019.
HVFi 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).
The authors' devised HVFi has the potential to predict the postoperative graft function.
作者设计了一种肝静脉流量指数（HVFi），使用术中经食管超声心动图和移植物重量，并研究其在原位肝移植后对移植物功能的预测价值。
前瞻性临床试验。
单中心三级学术医院。
2018 年 2 月至 2019 年 12 月期间接受背驮式原位肝移植的 97 例患者。
HVFi 定义为 HV 流量/移植物重量。发生早期移植物功能障碍（EAD）的患者在收缩期（HVFi sys，1.23 v 2.19 L/min/kg，p < 0.01）、舒张期（HVFi dia，0.87 v 1.54 L/min/kg，p < 0.01）、收缩期（HVF sys，2.04 v 3.95 L/min，p < 0.01）和舒张期（HVF dia，1.44 v 2.63 L/min，p < 0.01）的 HVFi 较低。EAD 患者的心脏死亡更多，测量时使用的血管加压药更多，急性排斥反应更多，总胆红素正常化时间（TIME t-bil）更长，手术时间更长，新肝时间更长，输注的浓缩红细胞更多。所有 HVF 参数与 TIME t-bil 呈负相关（HVFi sys R = -0.406，p < 0.01；HVFi dia R = -0.442，p < 0.01；HVF sys R = -0.44，p < 0.01；HVF dia R = -0.467，p < 0.01）。受试者工作特征曲线分析确定了 HVFi 预测 EAD 发生（HVFi sys <1.608，HVFi dia <0.784 L/min/kg）、急性排斥反应（HVFi sys <1.388，HVFi dia <1.077 L/min/kg）和延长高总胆红素（HVFi sys <1.471，HVFi dia <1.087 L/min/kg）的最佳截断值。
作者设计的 HVFi 具有预测术后移植物功能的潜力。
