This study was supported by a starter grant from the Department of Anesthesiology at the Penn State Milton S. Hershey Medical Center (Pennsylvania State University College of Medicine). There was no funding received from any other organization.
Association between plasma cyclic guanosine monophosphate levels and hemodynamic instability during liver transplantation
Article first published online: 12 FEB 2013
Copyright © 2012 American Association for the Study of Liver Diseases
Volume 19, Issue 2, pages 191–198, February 2013
How to Cite
Bezinover, D., Kadry, Z., Uemura, T., Sharghi, M., Mastro, A. M., Sosnoski, D. M., Dalal, P. and Janicki, P. K. (2013), Association between plasma cyclic guanosine monophosphate levels and hemodynamic instability during liver transplantation. Liver Transpl, 19: 191–198. doi: 10.1002/lt.23570
- Issue published online: 12 FEB 2013
- Article first published online: 12 FEB 2013
- Accepted manuscript online: 16 NOV 2012 01:23AM EST
- Manuscript Accepted: 23 OCT 2012
- Manuscript Received: 23 JUL 2012
The activation of cyclic guanosine monophosphate (cGMP) production in patients with end-stage liver disease (ESLD) has been associated with hemodynamic instability during orthotopic liver transplantation (OLT). The aim of this prospective, observational study was to investigate the involvement of cGMP in the mediation of profound hypotension during liver graft reperfusion. An additional objective was to determine whether preoperative cGMP levels are associated with intraoperative hemodynamic instability. Forty-four consecutive patients undergoing OLT were included in the study. Blood samples for cGMP analysis were obtained from (1) the radial artery before the surgical incision; (2) the radial artery, portal vein, and flush blood during the anhepatic phase; and (3) the radial artery 20 minutes after liver graft reperfusion. On the basis of a statistical analysis, the patients were divided into 2 groups: group 1 (preoperative cGMP level ≥ 0.05 μmol/L) and group 2 (preoperative cGMP level < 0.05 μmol/L). We demonstrated a significant correlation between the preoperative levels of cGMP and the amount of catecholamine required to maintain hemodynamic stability during reperfusion (r = 0.52, P < 0.001), the length of the hospital stay (r = 0.38, P = 0.01), and the length of the intensive care unit (ICU) stay (r = 0.44, P = 0.004). We also demonstrated a significantly higher intraoperative catecholamine requirement (P < 0.001) and a prolonged postoperative ICU stay (P = 0.02) in group 1 patients versus group 2 patients. In conclusion, this study demonstrates increased baseline cGMP production in patients with ESLD, which is significantly associated with severe hypotension during OLT. We suggest that preoperative levels of cGMP correlate with hemodynamic instability during liver graft reperfusion. Liver Transpl 19:191–198, 2013. © 2012 AASLD.