The effect of a new type of retrograde reperfusion on the intraoperative internal environment and hemodynamics during classic orthotopic liver transplantation / 中华普通外科杂志

ABSTRACT

Objective To investigate the effect of a new type of retrograde reperfusion on the intraoperative internal environment and hemodynamics during classic orthotopic liver transplantation (OLT).Methods 20 patients underwent classic OLT using a new type of retrograde reperfusion in our center.Blood sampling was done at different parts or time points includingbefore blood venting via the portal vein (PV) of the donor liver,5 ml of blood was collected from the superior vena cava (PSVC),inferior vena cava (PIVC) and portal vein (PPV).During retrograde reperfusion through the inferior vena cava (IVC),5 mL of blood was collected when the volume of blood venting reached 5 ml (T1),100 ml (T2),and 200 ml (T3),respectively.The differences of data were compared after the blood samples were analyzed.In addition,the number instances of postreperfusion syndrome (PRS) were recorded.Results All operations were completed successfully,in which PRS occurred in 4 patients (20％).The most notable findings are the significant changes of nearly all data at T1,T2 and T3,including pH value,PvO2,SvO2,BEecf,HCO3-,Lac,K +,and Ca2 +,compared with PIVC (P ＜ 0.05) and a trend toward recovery in all the data.Yet their levels at T3 did not come back to the levels at PIVC (P ＜ 0.05).Besides,for pH value,Lac,K +,HCO3-and BEecf,there were no significant differences between PSVC,PIVC and PPV (P ＞ 0.05).Conclusions During classic OLT,the main factors leading to a disordered internal environment after recirculation stem from venous retum within the donor liver.This new type of retrograde perfusion can eliminate some of the harmful metabolites inside the donor liver in time and to some extent reduce internal environment disorders as well as drastic hemodynamic fluctuations after recirculation.