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Intraoperative hemodynamic modifications during pediatric orthotopic liver transplantation
M Carlier1, L van Obbergh, F Veyckemans
1Department of Anesthesiology, University of Louvain, Brussels, Belgium.
Insights
Orthotopic liver transplantation (OLT) in children can cause cardiovascular changes. Careful fluid replacement and pressure monitoring during OLT help maintain hemodynamic stability in most pediatric patients.
Area of Science:
- Cardiovascular Physiology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Orthotopic liver transplantation (OLT) involves significant cardiovascular shifts during vascular clamping and revascularization.
- Pediatric OLT presents unique challenges in managing hemodynamic stability.
Purpose of the Study:
- To assess cardiovascular changes during pediatric OLT.
- To evaluate the effectiveness of fluid management in maintaining hemodynamic stability in children undergoing OLT.
Main Methods:
- Retrospective analysis of 60 OLT procedures in 52 children.
- Monitoring of pulmonary artery pressure (PAP), pulmonary wedge pressure (PWP), and systolic blood pressure (SBP).
- Documentation of veno-venous bypass and vasopressor use.
Main Results:
- IVC clamping typically led to a decrease in PAP and PWP, with stable SBP in 50% of cases.
- Veno-venous bypass was rarely needed (3 cases), and vasopressors were used infrequently (6 cases).
- Reperfusion (unclamping) often caused a significant SBP drop with increased PAP and PWP, though some hypovolemic patients showed decreased pressures.
Conclusions:
- Pediatric OLT can be managed with good hemodynamic stability.
- Adequate fluid replacement and vigilant monitoring of filling pressures are crucial for managing cardiovascular changes during pediatric OLT.
Abstract:
OLT is generally associated with important cardiovascular changes occurring during the vascular clamping and at the time of revascularization of the newly transplanted liver. In our series of 60 OLT performed in 52 children, the IVC clamping is generally followed by a fall in the PAP and the PWP, the SBP remaining fairly stable in half of the cases. This good tolerance is confirmed by the fact that a veno-venous bypass was used only in 3 instances and vasopressive drugs were needed in only 6 cases. At unclamping, a severe decrease in SBP is associated with a sharp rise in PAP and PWP in most of the cases, whereas some hypovolemic patients decrease their SBP, PAP and PWP. Therefore, we believe that adequate fluid replacement under careful monitoring of the filling pressures provides a good hemodynamic stability in most of the children during the different stages of OLT.