Factors affecting hemodynamic changes after reperfusion in liver transplantation

Background: The aim of this retrospective study was to determine if the duration of cold and warm ischemia times is related to the extent of these disturbances and also to identify other factors related to recipient's condition which may affect the severity of post reperfusion syndrome. Patients and methods. The authors studied the factors affecting hemodynamic changes after reperfusion in sixty-one patients submitted to liver transplantation at the University of Miami (Jackson Memorial Hospital) during the investigation period (August 1998-January 1999). The hemodynamic parameters monitored were heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary arterial pressure (MPAP), venous oxygen saturation (SVO ₂) and ASA status. All parameters were evaluated in three specific times: after skin incision (baseline, T ₁), 10 min. before reperfusion (T ₂), and 10 min. after reperfusion (T ₃). The statistical analyses were t-test for independent samples and ANOVA test. Results: All parameters changed significantly (p < 0.0001) at T ₁, T ₂ and T ₃. No correlation was found between cold and warm ischemia times and any of hemodynamic parameters in our study and no correlation was found between gender and those parameters. Age was significantly correlated with the MAP at T ₂. MAP was decreased in older patients at T ₂. HR, MAP, CVP, PAP and CVO ₂ were significantly correlated with ASA classification (p < 0.000033). Conclusions: No significant effects of cold and warm ischemia times on the hemodynamic intraoperative condition of the OLT were found. Furthermore, patients with a high ASA status were shown to be at an increased risk of cardiovascular collapse after reperfusion.