Systemic and splanchnic hemodynamic changes after liver transplantation for cirrhosis: A long-term prospective study

The effect of orthotopic liver transplantation (OLT) on the systemic and sp lanchnic hemodynamic alterations of cirrhosis is still largely unknown. The aim of this study was to prospectively investigate the long-term changes i nduced by OLT on several hemodynamic parameters. In 28 patients undergoing OLT for cirrhosis, the following parameters were measured before surgery an d subsequently at 6-month intervals (mean follow-up period, 17 months): car diac index, mean arterial pressure (MAP), heart rate, total peripheral resi stance (TPR), portal vein flow velocity and flow volume, spleen size, and D oppler ultrasound resistance or pulsatility indexes (RI or PI) in the: 1) i nterlobular renal, 2) superior mesenteric, 3) splenic, and 4) hepatic arter ies. The same parameters were measured in 10 healthy controls. After OLT, c ardiac index and heart rate significantly decreased (P <.01), while MAP and TPR increased (P <.001), so that any significant difference from controls disappeared. Renal RI progressively decreased, achieving a significant redu ction (P <.05) to normal values at the 12th month of follow-up, Portal flow velocity and hepatic and splenic RI returned to values not significantly d ifferent from controls. Portal flow volume increased over normal values aft er OLT (P <.001), and SMA PI, lower than normal before OLT, did not show an y statistically significant increase thereafter. Spleen size decreased sign ificantly, but persisted to be larger than in controls. In conclusion, syst emic, renal, and most, but interestingly not all, splanchnic circulatory al terations of cirrhosis are restored to normal after OLT.