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| 1 | Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation显示文摘Advanced liver cirrhosis is usually accompanied by portal hypertension. Long-term portal hypertension results in various vascular alterations. The systemic hemodynamic state in patients with cirrhosis is termed a hyperdynamic state. This peculiar hemodynamic state is characterized by an expanded blood volume, high cardiac output, and low total peripheral resistance. Vascular alterations do not disappear even long after liver transplantation(LT), and recipients with cirrhosis exhibit a persistent systemic hyperdynamic state even after LT. Stability of optimal systemic hemodynamics is indispensable for adequate portal venous flow(PVF) and successful LT, and reliable parameters for optimal systemic hemodynamics and adequate PVF are required. Even a subtle disorder in systemic hemodynamics is precisely indicated by the balance between cardiac output and blood volume. The indocyanine green(ICG) kinetics reflect the patient's functional hepatocytes and effective PVF, and PVF is a major determinant of the ICG elimination constant(kICG) in the well-preserved allograft. The kICG value is useful to set the optimal PVF during living-donor LT and to evaluate adequate PVF after LT. Perioperative management has a large influence on the postoperative course and outcome; therefore, key points and unexpected pitfalls for intensive management are herein summarized. Transplant physicians should fully understand the peculiar systemic hemodynamic behavior in LT recipients with cirrhosis and recognize the critical importance of PVF after LT. | Tomohide Hori Yasuhiro Ogura Yasuharu Onishi Hideya Kamei Nobuhiko Kurata Motoshi Kainuma Hideo Takahashi Shogo Suzuki Takashi Ichikawa Shoko Mizuno Tadashi Aoyama Yuki Ishida Takahiro Hirai Tomoko Hayashi Kazuko Hasegawa Hiromu Takeichi Atsunobu Ota Yasuhiro Kodera Hiroyuki Sugimoto Taku Iida Shintaro Yagi Kentaro Taniguchi Shinji Uemoto | 2016 | World Journal of Hepatology2016，8，25： | 3 |
| 2 | Transoesophageal echocardiography during liver transplantation显示文摘Liver transplantation(LT) has become the standard of care for patients with end stage liver disease. The allocation of organs, which prioritizes the sickest patients, has made the management of liver trans-plant candidates more complex both as regards their comorbidities and their higher risk of perioperative complications. Patients undergoing LT frequently display considerable physiological changes during the pro-cedures as a result of both the disease process and the surgery. Transoesophageal echocardiography(TEE), which visualizes dynamic cardiac function and overall contractility, has become essential for perioperative LT management and can optimize the anaesthetic management of these highly complex patients. More-over, TEE can provide useful information on volume status and the adequacy of therapeutic interventions and can diagnose early intraoperative complications, such as the embolization of large vessels or development of pulmonary hypertension. In this review, directed at clinicians who manage TEE during LT, we show why the procedure merits a place in challenging anaesthetic environment and how it can provide essential information in the perioperative management of compromised patients undergoing this very complex surgical procedure. | Lesley De Pietri Federico Mocchegiani Chiara Leuzzi Roberto Montalti Marco Vivarelli Vanni Agnoletti | 2015 | World Journal of Hepatology2015，7，23： | 0 |
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