Lack of a correlation between portal vein flow and pressure: Toward a shared interpretation of hemodynamic stress governing inflow modulation in liver transplantation

Authors

  • Mauricio Sainz-Barriga,

    1. Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium
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  • Luigia Scudeller,

    1. Clinical Epidemiology and Biometric Unit, IRCCS Policlinico San Matteo, Pavia, Italy
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  • Maria Gabriella Costa,

    1. Clinic of Anesthesia and Intensive Care Medicine, Department of Clinical and Experimental Medical Sciences, Medical School of the University of Udine, Udine, Italy
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  • Bernard de Hemptinne,

    1. Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium
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  • Roberto Ivan Troisi

    Corresponding author
    1. Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium
    • Liver Transplantation Service, Department of General and Hepatobiliary Surgery, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
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    • Telephone: +32 9332 5519; FAX: +32 9332 3891


Abstract

The portal vein flow (PVF), portal vein pressure (PVP), and hepatic venous pressure gradient (HVPG) were prospectively assessed to explore their relationships and to better define hyperflow and portal hypertension (PHT) during liver transplantation (LT). Eighty-one LT procedures were analyzed. No correlation between PVF and PVP was observed. Increases in the central venous pressure (CVP) were transmitted to the PVP (58%, range = 25%-91%, P = 0.001). Severe PHT (HVPG ≥ 15 mm Hg) showed a significant reciprocal association with high PVF (P = 0.023) and lower graft survival (P = 0.04). According to this initial experience, an HVPG value ≥ 15 mm Hg is a promising tool for the evaluation of hemodynamic stress potentially influencing outcomes. An algorithm for graft inflow modulation based on flows, gradients, and systemic hemodynamics is provided. In conclusion, the evaluation of PHT severity with PVP could be delusive because of the influence of CVP. PVF and PVP do not correlate and should not be used individually to assess hyperflow and PHT during LT. Liver Transpl 17:836-848, 2011. © 2011 AASLD.

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