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World Journal of Surgery

, Volume 34, Issue 8, pp 1864–1873 | Cite as

Effects of Low Central Venous Pressure During Preanhepatic Phase on Blood Loss and Liver and Renal Function in Liver Transplantation

  • Zhi-Ying Feng
  • Xiao Xu
  • Sheng-Mei Zhu
  • Berthold Bein
  • Shu-Sen ZhengEmail author
Article

Abstract

Background

Although the low central venous pressure (LCVP) technique is used to decrease blood loss during liver resection, its efficacy and safety during transplant procedures are still debatable. Our study aimed to assess the effects of this technique and its clinical safety for recipients undergoing liver transplantation.

Methods

Eighty-six adult patients were randomly divided into a LCVP group and a control group. In the LCVP group, CVP was maintained below 5 mmHg or 40% lower than baseline during the preanhepatic phase by limiting infusion volume, manipulating the patient’s posture, and administration of somatostatin and nitroglycerine. Recipients in the control group received standard care. Hemodynamics, blood loss, liver function, and renal function of the two groups were compared perioperatively.

Results

A lower CVP was maintained in the LCVP group during the preanhepatic phase, resulting in a significant decrease in blood loss (1922 ± 1429 vs. 3111 ± 1833 ml, P < 0.05) and transfusion volume (1200 ± 800 vs. 2400 ± 1200 ml, P < 0.05) intraoperatively. Compared with the control group, the LCVP group had a significantly lower mean arterial pressure at 2 h after the start of the operation (74 ± 11 vs. 84 ± 14 mmHg, P < 0.05), a lower lactate value at the end of the operation (5.9 ± 3.0 vs. 7.2 ± 3.0 mmol/l, P < 0.05), and a better preservation of liver function after the declamping of the portal vein. There were no significant differences in perioperative renal function and postoperative complications between the groups.

Conclusions

The LCVP technique during the preanhepatic phase reduced intraoperative blood loss, protected liver function, and had no detrimental effects on renal function in LT.

Keywords

Liver Transplantation Mean Arterial Pressure Central Venous Pressure Fresh Freeze Plasma Live Donor Liver Transplant 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

ALT

Alanine transaminase

AST

Aspartate transaminase

BUN

Blood urea nitrogen

CR

Creatinine

CVP

Central venous pressure

DO2I

Oxygen delivery index

FFP

Fresh frozen plasma

INR

International normalized ratio

LCVP

Low central venous pressure

LDLT

Living donor liver transplantation

LT

Liver transplantation

MAP

Mean arterial pressure

MELD

Model for end-stage liver disease

MODS

Multiple-organ dysfunction syndromes

PAWP

Pulmonary arterial wedge pressure

PT

Prothrombin time

PVP

Portal vein pressure

RBC

Red blood cell

TB

Total bilirubin

VO2I

Oxygen consumption index

Notes

Acknowledgments

This study was supported by grants from the National Science and Technology (S & T) major project, China (2008ZX10002-026), and the Science and Technology Bureau of Zhejiang Province, China (2009C33091).

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Copyright information

© Société Internationale de Chirurgie 2010

Authors and Affiliations

  • Zhi-Ying Feng
    • 1
  • Xiao Xu
    • 2
  • Sheng-Mei Zhu
    • 1
  • Berthold Bein
    • 3
  • Shu-Sen Zheng
    • 2
    Email author
  1. 1.Department of Anaesthesiology, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouChina
  2. 2.Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of MedicineZhejiang UniversityHangzhouPeople’s Republic of China
  3. 3.Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital Schleswig-HolsteinCampus KielKielGermany

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