HEMODYNAMIC AND METABOLIC EFFECTS OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS) DURING ANESTHESIA FOR ORTHOTOPIC LIVER-TRANSPLANTATION

Recently, the transjugular intrahepatic portosystemic shunt (TIPS) has been advocated as a safe bridge to orthotopic liver transplantation ( OLT). We retrospectively studied 53 consecutive cirrhotic patients who underwent OLT: 27 patients with TIPS were compared to 26 controls. He modynamic and oxy phoretic data (Fick method) were collected during si x phases of OLT. There were no significant differences in demographic data and Child-Pugh class, nor in surgical time and blood product requ irements before the anhepatic phase between TIPS patients and controls . In the TIPS group, we observed a marked hyperdynamic profile with a lower systemic vascular resistance index, higher cardiac index, and de pressed oxygen consumption before native liver removal. During the sam e period, the TIPS group developed a greater acidosis and was treated with a larger amount of Na-HCO3. Following the anhepatic phase, no dif ferences between the two groups were detected. All transplantations we re successful, and no complications related to TIPS were observed. The se results seem to be the consequence of a reduced liver function rese rve with a direct hemodynamic effect due to the TIPS.