K. Fukuzawa et al., FLUSHING WITH AUTOLOGOUS BLOOD IMPROVES INTRAOPERATIVE HEMODYNAMIC STABILITY AND EARLY GRAFT FUNCTION IN CLINICAL HEPATIC TRANSPLANTATION, Journal of the American College of Surgeons, 178(6), 1994, pp. 541-547
Hemodynamic instability and hyperkalemia are common after reperfusion
and may cause ischemic damage on the hepatic allograft. Two techniques
for flushing hepatic grafts before reperfusion were studied to evalua
te their effects on intraoperative hemodynamic and metabolic status an
d on early graft function in 83 consecutive adult hepatic transplantat
ions. In the first 41 patients (group 1), the hepatic grafts were rins
ed with 500 milliliters of lactated Ringer's solution (LR). In the sub
sequent 42 patients (group 2), in addition to LR rinse, the first 500
milliliters of portal blood to flush and reperfuse the liver were drai
ned through the cannula inserted into the donor vena cava before uncla
mping the vena cava. After reperfusion, the mean arterial pressure dec
reased 30+/-4 percent in group 1 versus 17+/-2 percent in group 2 (p<0
.02), and serum K+ increased by 1.9+/-0.2 in group 1 versus 0.8+/-0.2
milliequivalents per liter in group 2 (p<0.01). Hyperkalemic cardiac a
rrest was only seen in two patients in group 1. The K+ concentration i
n the first 100 milliliters of dis carded blood was found to be 40+/-2
milliequivalents per liter. The 500 milliliters of discarded blood co
ntained 8.31+/-0.4 milliequivalents, which was correlated with graft l
iver weight (p<0.001). Early graft function, as measured by serum glut
amic-oxaloacetic transaminase, serum glutamic pyruvic transaminase, to
tal bilirubin and prothrombin time on postoperative day No. 2, was sig
nificantly better in group 2 than in group 1 (p<0.05). The six-month g
raft and patient survival rates in group 1 were 66 and 75 percent, ver
sus 90 and 95 percent in group 2 (p<0.01 and p<0;02, respectively). Fu
rther flushing with 500 milliliters of autologous portal blood resulte
d in smaller intraoperative shifts in serum K+, greater hemodynamic st
ability, better graft function and improved graft and patient survival
.