Intramucosal pH monitoring during liver transplantation

To apply tonometry as a quick estimation of the early liver graft function.

Forty-five liver-transplanted patients were examined. Data were collected prospectively and analysed retrospectively. According to the early graft function, patients were classified into two groups: in group 1 (n = 28) adequate graft function, in group 2 (n = 17) deteriorated graft function was detected in the early post-operative period. Complete conventional and volumetric haemodynamic monitoring and intramucosal pH (pHi), regional CO2 tension (PrCO2) measurements were performed during surgery and until the 36 hours post-operatively.

In group 2 the packed blood cell, fresh frozen plasma consumption intraoperatively, and the time of hepatectomy were significantly higher; ICU treatment days, respiration time was longer and mortality rate was higher. Almost the whole examination period pHi was mostly below 7.3 and PrCO2 above 50 mmHg in group 2. There were significant differences in pHi between the groups from the preparation phase until the 24th post-operative hour. In group 2, there were significantly lower values in cardiac output in the whole examination period and in the mean arterial pressure values in the revascularization phase. In group 1, the oxygen delivery values were significantly higher in the preparation phase and oxygen consumption values after revascularization phase. With regression analysis there were no significant correlations between pHi, PrCO2 and global haemodynamic parameters.

Regional parameters were completely different from global haemodynamic parameters, therefore pHi and PrCO2 can be a good indicator of the early liver graft dysfunction.