Changes And Distribution Of Blood Volume During Liver Transplantation And Inflammatory Reaction State: A Clinical Study

Orthotopic liver transplantation (OLT) is the only effective treatment for end-stage hepatic failure. With accumulating experience with clinical anesthesia and progress in anesthesiology research, anesthesia management during liver transplantation has advanced drastically. However, issues pertaining to the perioperative stage of liver transplantation such as blood volume assessment, multiple organ failure including pulmonary and renal injury as well as infection are key factors deterring elevation in the success rate of liver transplantation. In particular, issues including timely and accurate assessment of blood volume, the role of inflammatory mediators in the perioperative stage of liver transplantation and the relationship between inflammatory mediators and blood volume and hemodynamics, as well as the mechanism by which post-reperfusion syndrome leads to severe hemodynamic disturbance have not been unraveled yet.Blood volume is the key factor maintaining hemodynamic stability, tissue oxygenation and homeostasis. Clinically, hemodynamic parameters, such as CO, CVP, and PCWP are usually used to assess systemic blood volume and left and right ventricular preload. Nevertheless, these parameters directly reflecting pressure instead of volume are influenced by such factors as intrathoracic pressure, cardiac function, vein compliance, and body posture, and thus cannot accurately reflect changes in effective circulating blood volume. Our long-term experience with anesthesia management of patients undergoing liver transplantation indicates that blood volume assessment in the perioperative stage of liver transplantation is very difficult. Due to severe preoperative condition of patients, particularly retention of sodium and water, abnormal distribution of electrolytes and great changes of angiotasis in patients with decompensated cirrhosis, the commonly used parameters including BP, HR, CO, CVP, and PCWP give rise to obvious errors in assessing effective circulating blood volume. For instance, with increases in CVP, PCWP and HR and urine volume reduction, fast infusion of fluid will...