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Lack of a correlation between portal vein flow and pressure: Toward a shared interpretation of hemodynamic stress governing inflow modulation in liver transplantation
Author(s) -
SainzBarriga Mauricio,
Scudeller Luigia,
Costa Maria Gabriella,
de Hemptinne Bernard,
Troisi Roberto Ivan
Publication year - 2011
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.22295
Subject(s) - medicine , liver transplantation , portal venous pressure , hemodynamics , cardiology , venous pressure , central venous pressure , portal hypertension , portal vein , transplantation , vein , surgery , blood pressure , heart rate , cirrhosis
Abstract The portal vein flow (PVF), portal vein pressure (PVP), and hepatic venous pressure gradient (HVPG) were prospectively assessed to explore their relationships and to better define hyperflow and portal hypertension (PHT) during liver transplantation (LT). Eighty‐one LT procedures were analyzed. No correlation between PVF and PVP was observed. Increases in the central venous pressure (CVP) were transmitted to the PVP (58%, range = 25%‐91%, P = 0.001). Severe PHT (HVPG ≥ 15 mm Hg) showed a significant reciprocal association with high PVF ( P = 0.023) and lower graft survival ( P = 0.04). According to this initial experience, an HVPG value ≥ 15 mm Hg is a promising tool for the evaluation of hemodynamic stress potentially influencing outcomes. An algorithm for graft inflow modulation based on flows, gradients, and systemic hemodynamics is provided. In conclusion, the evaluation of PHT severity with PVP could be delusive because of the influence of CVP. PVF and PVP do not correlate and should not be used individually to assess hyperflow and PHT during LT. Liver Transpl 17:836‐848, 2011. © 2011 AASLD.