Brown Audrey E, Roberts John
Department of Surgery, University of California, California, San Francisco, USA.
Department of Transplant Surgery, University of California, California, San Francisco, USA.
Clin Transplant. 2025 Feb;39(2):e70074. doi: 10.1111/ctr.70074.
Multiple intraoperative hemodynamic parameters are associated with an increased risk of early allograft dysfunction (EAD) following living donor liver transplantation (LDLT); however, there is significant center-to-center variability in terms of which parameters are used. We sought to determine which intraoperative hemodynamic parameters are most predictive of EAD following LDLT.
This is a systematic review following PRISMA guidelines (PROSPERO ID: CRD42023409711). Receiver operating characteristic (ROC) analyses were used to compare predictive parameters.
A total of 4399 articles were identified from 3 large, international databases (PubMed, Embase, and Web of Science). Eighteen articles fit the inclusion criteria. The most commonly evaluated hemodynamic parameter was the postreperfusion portal venous pressure (PVP). A postreperfusion PVP of <15-20 mmHg was consistently associated with lower rates of EAD and, in some cases, improvements in patient survival. Other hemodynamic parameters evaluated included portal venous flow, hepatic arterial flow, portal venous velocities, and the hyperperfusion index.
Hemodynamic measurements indicative of portal hyperperfusion, especially elevated PVP, have been consistently associated with the development of EAD. Intraoperative hemodynamics should be monitored on all LDLT recipients, with portal inflow modulation procedures indicated if portal hyperperfusion is present.
多项术中血流动力学参数与活体肝移植（LDLT）后早期移植物功能障碍（EAD）风险增加相关；然而，在使用哪些参数方面，各中心之间存在显著差异。我们试图确定哪些术中血流动力学参数对LDLT后EAD最具预测性。
这是一项遵循PRISMA指南的系统评价（PROSPERO编号：CRD42023409711）。采用受试者工作特征（ROC）分析来比较预测参数。
从3个大型国际数据库（PubMed、Embase和Web of Science）中总共识别出4399篇文章。18篇文章符合纳入标准。最常评估的血流动力学参数是再灌注后门静脉压力（PVP）。再灌注后PVP<15 - 20 mmHg一直与较低的EAD发生率相关，在某些情况下，还与患者生存率的提高有关。评估的其他血流动力学参数包括门静脉血流、肝动脉血流、门静脉流速和高灌注指数。
提示门静脉高灌注的血流动力学测量，尤其是升高的PVP，一直与EAD的发生相关。所有LDLT受者均应监测术中血流动力学，如果存在门静脉高灌注，则应采取门静脉流入调节措施。
