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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2010 October;76(10):795-804
Central venous pressure during the post-anhepatic phase is not associated with early postoperative outcomes following orthotopic liver transplantation
Cywinski J. B. 1, Mascha E. 2, You J. 2, Argalious M. 3, Kapural L. 4, Christiansen E. 3, Parker B. M. 3 ✉
1 Departments of General Anesthesiology and Outcome Research, Cleveland Clinic, Cleveland, OH, USA;
2 Department of Quantitative Health Sciences, and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA;
3 Department of Comprehensive Pain Management and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA;
4 Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA; 5Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA
BACKGROUND: Fluid management during orthotopic liver transplantation poses unique challenges for the anesthesiologist. Maintenance of hypovolemia as indicated by low central venous pressure has been associated with reduced blood loss and improved outcomes in some studies, but with higher 30-day mortality and increased incidence of renal dysfunction in others. The primary aim was to evaluate the association of central venous pressure management after liver allograft reperfusion with immediate postoperative patient outcomes.
METHODS: This was a retrospective investigation evaluating the intraoperative and postoperative records of 144 consecutive patients who underwent orthotopic liver transplantation at a single institution.
RESULTS: We did not find any important association between central venous pressure management after graft reperfusion and postoperative patient outcomes. Specifically, these data do not support the hypothesis that maintenance of lower central venous pressure during the post-anhepatic phase of orthotopic liver transplantation is associated with improved immediate postoperative allograft function (except for a steeper decrease in post operative days 1-3 in 2 of the 3 liver function test: alanine aminotransferase and bilirubin) or overall patient survival, graft survival, composite graft/patient survival, intensive care lenght of stay, hospital lenght of stay or the occurrence of infections.
CONCLUSION: Maintaining a lower central venous pressure during the post-anhepatic phase during orthotopic liver transplantation is not associated with any benefit in terms of immediate postoperative allograft function, graft survival or patient survival.