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Predictive Value of Intraoperative Pulmonary Vascular Resistance in Liver Transplantation
Author(s) -
Park Jungchan,
Lee SeungHwa,
Kim Jeayoun,
Park Soo Jung,
Park Myung Soo,
Choi GyuSeong,
Lee SukKoo,
Kim Gaab Soo
Publication year - 2018
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.25341
Subject(s) - medicine , liver transplantation , hazard ratio , vascular resistance , confidence interval , heart transplantation , cardiology , transplantation , hemodynamics , surgery
We aimed to evaluate the association between intraoperative pulmonary vascular resistance (PVR) and clinical outcome of liver transplantation (LT). Cardiovascular involvement of end‐stage liver disease is relatively common, and hemodynamic instability during LT can be fatal to recipients. However, the clinical impact of intraoperative PVR in LT remains undetermined. A total of 363 adult recipients with intraoperative right heart catheterization from January 2011 to May 2016 were analyzed. Patients were divided into 2 groups according to PVR. Two separate analyses were performed according to the time point of measurement: at the beginning and at the end of LT. The primary outcome was all‐cause death or graft failure during the follow‐up period. Increased PVR was observed in 11.8% (43/363) of recipients at the beginning and 12.7% (46/363) of recipients at the end of LT. PVR at the beginning of LT had no significant effect on the rate of death or graft failure in the multivariate analysis (hazard ratio [HR], 1.24; 95% confidence interval [CI], 0.64‐2.38; P = 0.52). In contrast, PVR at the end of LT was significantly associated with death or graft failure during the overall follow‐up period (HR, 2.00; 95% CI, 1.13‐3.54; P = 0.02). In conclusion, PVR at the end of LT, rather than the beginning, is associated with clinical outcome. Larger trials are needed to support this finding.