IMPROVED HEMODYNAMIC STABILITY WITH ADMINISTRATION OF APROTININ DURING ORTHOTOPIC LIVER-TRANSPLANTATION

In a placebo-controlled, double-blind study, we have investigated the hypothesis that patients for orthotopic liver transplantation (OLT) tr eated with high-dose aprotinin (serum concentrations greater than or e qual to 200 kiu ml(-1)) show greater haemodynamic stability on graft r eperfusion. We studied 55 adult patients presenting for OLT, and 52 we re included in the analysis. The treatment and placebo groups were sim ilar in patient characteristics. The anaesthetic regimen used was stan dardized, and veno-venous bypass were used in all patients. Cardiac ou tput measurements and haemodynamic profiles were recorded at intervals throughout anaesthesia and surgery. Arterial and mixed venous oxygen saturations were measured by co-oximetry. Derived variables were measu red using standard formulae. Aprotinin treated patients had greater va lues for systemic vascular resistance on reperfusion, with a lesser ca rdiac index and calculated oxygen delivery. Oxygen consumption, howeve r, was significantly greater, despite reduced delivery.