[Changes in hemodynamics and nitric oxide/endothelin-1 during liver transplantation in patients with cirrhosis].

OBJECTIVE: To study the systemic and pulmonary hemodynamic changes of patients with cirrhosis during liver transplantation and evaluate the role of nitric oxide (NO) and endothelin-1(ET-1).

METHODS: Twenty-four patients with cirrhosis at terminal stage underwent modifying piggy-back liver transplantation. Hemodynamic parameters including cardiac index (CI), arterial blood pressure (ABP) and pulmonary arterial pressure (PAP) were monitored continuously. NO and ET-1 levels were measured by radioimmunoassay. Blood samples were obtained from superior vena cava at induction of anesthesia (T1), 10 minutes before vascular cross clamping (T2), 30 minutes after vascular cross clamping (T3), 30 minutes after reperfusion of the new liver (T4), and at the end of surgery (T5).

RESULTS: (1) Mean arterial blood pressure (MABP) lowered significantly in the early stage of anhepatic period and neohepatic period (P<0.05 or P<0.01). (2) Central venous pressure (CVP), mean pulmonary arterial pressure (MPAP) and pulmonary arterial wedge pressure (PAWP) lowered significantly during anhepatic period. They rose significantly after graft reperfusion, and remained at a high level with respect to the baseline level (P<0.05). (3) CI declined significantly during anhepatic period and increased 10 minutes after reperfusion of new liver. (4) Systemic vascular resistance index and pulmonary vascular resistance index increased during anhepatic period and were higher than the baseline level 15 minutes after reperfusion. SVRI was lower than baseline level 30 minutes after reperfusion. (5) Compared with the baseline level, NO decreased significantly after vascular cross-clamping and elevated 30 minutes after reperfusion. ET levels were significant elevated 30 minutes after clamping and after reperfusion (P<0.05).

CONCLUSION: Significant hemodynamic changes occur in patients with cirrhosis during liver transplantation, and pulmonary hypertension develops during neohepatic period. The role of elevated contents of NO and ET-1 after reperfusion needs further study.