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

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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.

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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

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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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Authors and Affiliations

  1. Department of Anaesthesiology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

    Zhi-Ying Feng & Sheng-Mei Zhu

  2. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 QingChun Road, Hangzhou, 310003, People’s Republic of China

    Xiao Xu & Shu-Sen Zheng

  3. Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

    Berthold Bein

Authors
  1. Zhi-Ying Feng
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  2. Xiao Xu
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Correspondence to Shu-Sen Zheng.

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Feng, ZY., Xu, X., Zhu, SM. et al. Effects of Low Central Venous Pressure During Preanhepatic Phase on Blood Loss and Liver and Renal Function in Liver Transplantation. World J Surg 34, 1864–1873 (2010). https://doi.org/10.1007/s00268-010-0544-y

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