The optimal volume of plasma to flush out preservation fluid in retrograde reperfusion during liver transplantation
10.3760/cma.j.issn.1007-8118.2016.04.006
- VernacularTitle:肝移植中逆灌注条件下经门静脉血浆冲洗的最佳灌洗量
- Author:
Fang YANG
;
Xu ZHU
;
Yi JIANG
- Publication Type:Journal Article
- Keywords:
Liver transplantation;
Retrograde reperfusion;
Perfusion volume
- From:
Chinese Journal of Hepatobiliary Surgery
2016;22(4):239-243
- CountryChina
- Language:Chinese
-
Abstract:
Objective To determine the optimal volume of plasma that should be used to perfuse through the portal vein (PV) to washout preservation fluid in retrograde reperfusion during liver transplantation.Methods The clinical data of S0 patients who underwent orthotopic liver transplantation (OLT) using retrograde reperfusion via the inferior vena cava (IVC) in our hospital from January 2011 to October 2013 were retrospectively analyzed.The patients were divided into two groups based on the volume of plasma infused via the PV to flush out the preservation fluid.Group 1:27 patients who received 400 ml,and Group 2:23 patients who received 1 200 ml.The preoperative and intraoperative data of the two groups were compared and analyzed.The serum concentrations of K+,Na+,Ca2+,mean arterial pressure (MAP) and pH were continuously monitored in the transplant recipients at different time points during liver transplantation.In addition,for patients in Group 2,the serum K +,Na + and Ca2 + concentrations in the samples of effluent fluid from the liver grafts were collected via the anastomotic stoma of the infrahepatic IVC and measured after infusion of 200 ml,400 ml,600 ml,800 ml,1 000 ml,or 1 200 ml of plasma.Results There were no significant differences in the preoperative and intraoperative data between the two groups.The plasma concentration of K + in Group 1 was significantly higher than that of Group 2 at 1 min after PV revascularization (T3) [(4.31 ± 0.54) mmol/L vs (3.96 ± 0.58) mmol/L,P ＜ 0.05],while the pH was significantly lower in Group 1 than that of in Group 2 (7.26 ± 0.02 vs 7.30 ± 0.04,P ＜ 0.05).The plasma Na + and Ca2 +concentrations,as well as the MAP,were not significantly different between the two groups at this time point.In group 2,no significant changes were observed in Ca2+ concentration in IVC blood following perfusion of 200 ml plasma.The insignificant changes in Na + after perfusion of 400 ml of plasma and for K + after 800 ml of plasma (P ＞ 0.05).Conclusions The electrolyte concentrations,blood pressure and arterial blood pH were fairly normal after resuming flow with PV revascularization after a perfusion volume of 800 ml of plasma.This volume was the most appropriate perfusion volume,balancing its effectiveness with economy to wash out any UW solution during OLT using retrograde reperfusion.
