Is there occult tissue ischemia in chronic end-stage liver disease?

Whether pathological oxygen supply dependency exists in patients with chron ic end-stage liver disease (CESLD) is unknown, although the frequently occu rring multiorgan dysfunction seen in these patients may be the result of oc cult tissue ischemia. In this study, 15 adult patients with CESLD were eval uated for the presence of pathological oxygen supply dependency and, thus, occult tissue ischemia before undergoing orthotopic liver transplantation. Whole-body oxygen consumption (Vo(2)) was measured using indirect calorimet ry at baseline, at reduced oxygen delivery (Do(2)) using positive end-expir atory pressure, and at increased Do(2) using Volume infusion. As a group, n o significant increase or decrease in Vo(2) was observed with changes in Do (2), However, 4 patients showed increases in Vo(2) of 14%, 10.8%, 9.6%, and 8.2% when Do(2) was increased, The study results suggest that pathological oxygen supply dependency is present in a subset of patients with CESLD, an d the existence of occult tissue ischemia is speculated. Copyright (C) 1999 by the American Association for the Study of Liver Diseases.