ABSTRACT
Objective To describe the hemodynamic changes during piggyback liver transplantation (PBLT), and to analyze the hemodynamic correlation with various degrees of cirrhosis according to Childpugh classification. Methods Between March 1999 and June 2004, 180 patients underwent PBLT procedure in our institution, and 95 cases were selected and divided according to Child classification. The intraoperative hemodynamics of different time points were retrospectively analyzed, including mean artery pressure (MAP), heart rate (HR), central vein pressure (CVP) and mean pulmonary artery pressure (MPAP). Results Hemodynamic changes were minimal before and during anhepatic phase in all the patients. At reperfusion, a hemodynamic disturbance occurred featured by decrease of MAP and increase of MPAP. Comparison between different Child class showed that in the Child C group, MAP were lower and HR were higher before new liver phase, while CVP and MPAP were higher during new liver phase. Conclusion Hemodynamic changes were minimal before and during anhepatic phase for PBLT, while they were more severe during reperfusion, and they also correlates with the different Child class before transplantation. The more severe of the cirrhosis before transplantation according to Child classification, the greater hemodynamic changes during the operation.
ABSTRACT
Objective To explore the correlation between liver volume variation of posthepatitic cirrhosis patients and the severity of the disease. Methods One hundred and eleven patients with normal livers and 74 posthepatitic cirrhosis patients underwent volume CT scan. The relation between normal liver volume and body height, body weight and body surface area was studied by linear regression and correlation method, the standard liver volume equation was deduced. The change ratio of liver volume in cirrhotic patients was calculated and compared with Child classification. Results The mean normal liver volume of Chinese adults was (1 225.15?216.23) cm~3, there was a positive correlation between liver volume and body height, body weight 〔liver volume (cm~3)=12.712?body weight (kg)+450.44〕 and body surface area 〔liver volume (cm~3)=876.02?body surface area (m~2)-297.17〕. The mean liver volume of Child A, B and C patients were (1 077.77?347.01) cm~3, (1 016.35?348.60) cm~3 and (805.73?208.85) cm~3 respectively. The liver volume and liver volume index was significantly smaller in Child C patients than those in Child A and B patients (P
ABSTRACT
BACKGROUND: Malnutrition frequently occurs in patients with liver cirrhosis independently for its etiology and can modify prognosis of the disease. Since malnutrition was observed at all clinical stages, but more frequently seen at advanced stages, early and detailed nutritional assessment in all patients with liver cirrhosis is important. The aims of this study are to define the nutritional status and the difference of nutritional index according to etiology and Child classification in patients with liver cirrhosis in Korea. METHODS: A total 138 cirrhotic patients (41 alcoholic cirrhosis, 97 virus-related cirrhosis) were studied. The diagnosis of cirrhosis was based on clinical, laboratory and ultrasonographic criteria and liver biopsy. The patients were divided into three groups according to the severity of their liver disease as assessed by the Child-Pugh classification. Nutritional parameter of protein (serum albumin, serum transferrin, total lymphocyte count) were measured. RESULTS: The patients with protein malnutrition are as follows: albumin 55, transferrin 68, total lymphocyte count 8. The frequency of moderate to severe protein malnutrition was high in alcoholic cirrhosis.: albumin (<2.9 g/dL) (26.8% vs 17.5%), transferrin (<180 mg/dL) (48.5% vs 24.8%), total lymphocyte count (<1200 number/L) (2.4% vs 2.0%). The mean value of nutritional index correlated with the degree of liver function impairment. (Child C showed the lowest value). CONCLUSION: In spite of limitation of nutritional index in this study, our study showed that severe protein-energy malnutrition was rare in Korea, and protein-energy malnutrition was not only more common in alcoholic cirrhosis but related to the severity of liver disease. Therefore, our data suggests that clinician should understand the importance of not imposing unnecessary restrictions and supplementation on protein intake for fear of imbalance of nutrition.