Persistence of systemic and splanchnic hyperkinetic circulation in liver transplant patients

Portal pressure and portal‐systemic collateral circulation after orthotopic liver transplantation have not been investigated. We studied systemic and splanchnic hemodynamics in 17 patients with cirrhosis before and 205 ± 146 days after orthotopic liver transplantation. Among the 17 orthotopic liver...

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Published in:Hepatology (Baltimore, Md.) Md.), 1993-02, Vol.17 (2), p.175-178
Main Authors: Hadengue, Antoine, Lebrec, Didier, Moreau, Richard, Sogni, Philippe, Durand, François, Gaudin, Christophe, Bernuau, Jacques, Belghiti, Jacques, Gayet, Brice, Erlinger, Serge, Benhamou, Jean‐Pierre
Format: Article
Language:English
Subjects:
Adult
Aged
Azygos Vein - physiopathology
Biological and medical sciences
Blood Circulation
Cardiac Output
Graft Rejection
Hemodynamics
Humans
Liver Circulation
Liver Diseases - physiopathology
Liver Transplantation
Liver, biliary tract, pancreas, portal circulation, spleen
Medical sciences
Middle Aged
Postoperative Period
Regional Blood Flow
Splanchnic Circulation
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Venous Pressure
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Summary:Portal pressure and portal‐systemic collateral circulation after orthotopic liver transplantation have not been investigated. We studied systemic and splanchnic hemodynamics in 17 patients with cirrhosis before and 205 ± 146 days after orthotopic liver transplantation. Among the 17 orthotopic liver transplantation patients, 12 had undergone hemodynamic study in the 6 mo before orthotopic liver transplantation. Controls were 50 patients with normal liver architecture. Cardiac index remained elevated in orthotopic liver transplantation patients compared with controls (3.6 ± 0.9 vs. 3.1 ± 0.4 L/min · m2; p < 0.05). Azygos blood flow, which was elevated before orthotopic liver transplantation (585 ± 402 ml/min), remained elevated after orthotopic liver transplantation (553 ± 343 ml/min). In transplant patients, hepatic blood flow was higher than it was in controls (2.26 ± 0.86 vs. 1.38 ± 0.57 L/min; p < 0.05). Elevated hepatic blood flow correlated with cardiac index (r = 0.647, p < 0.025). In patients with normal graft function, hepatic venous pressure gradient was normal (2 ± 1 mm Hg). In a patient with acute rejection, a sharp elevation in the hepatic venous pressure gradient was observed; it returned to normal 45 days after treatment. We conclude that despite normal portal pressure, portal‐systemic collateral blood flow remains elevated after orthotopic liver transplantation. Possibly because of persistent collateral circulation, which may keep portal tributary blood flow elevated, hepatic blood flow is increased after orthotopic liver transplantation. Elevated splanchnic blood flow, in turn, contributes to the high cardiac index in liver recipients. Finally, a sharp elevation in portal pressure, which may be observed during acute rejection and subsides after treatment, merits further study. (HEPATOLOGY 1993;17:175–178.)
ISSN:0270-9139
1527-3350
DOI:10.1002/hep.1840170202