[Acid-base disturbances during liver transplantation]

Objective of the study is to assess the contribution of different factors in the development of acid-base disturbances at the stages of liver transplantation. MATHERIALS AND METHODS: The analysis of right lobe relative liver transplantation was held in 86 recipients. 22 patients corresponded to ASA III (group 1), ASA IV - 50 patients (group 2), and ASA V - 14 patients (group 3). Blood samples were studied by pH, SB, lactate, pCO2 at the stages: up to the beginning, before v. cava inferior cross-clamping, before blood flow launch, on the 1st minute after blood flow launch, 5 min after blood flow launch. 1 hour after the blood flow launch, 2 hours after blood flow launch, at the end of operations. Cardiac index and oxygen delivery were also estimated

The preliverless stage was characterized by a decrease in pH, SB. BE and increased lactate, oxygen delivery slightly reduced due to the reduction of oxygen blood capacity, cardiac index remained within the normal range. During liverless period, the growth rate of lactate was different in all three groups, DO2 was below the norm, CI - on the lower bound of the norm. Blood flow launch was accompanied by a peak values of pH, SBC, BE, lactate and increased pCO2.

The main factor in the development of metabolic acidosis during preliverless stage is lactate growth as a consequence of decreased hepatic lactate clearance and blood loss. During liverless period the most significant impact contributes to reduced cardiac output, which, together with reduced oxygen blood capacity leads to a decrease in tissue DO2. Increased production of lactate, together with a decrease in its clearance due to liver shutdown from the bloodstream leads to higher rates of lactate growth in this period. When starting the blood flow in addition to the release of acidic substances, growth of endogenous CO2 leads to the peak pH values.