Hepatic hemodynamic changes during liver transplantation: A review

Abstract

Liver transplantation is performed in the recent decades with great improvements not only technically but also conceptually. However, there is still lack of consensus about the optimal hemodynamic characteristics during liver transplantation. The representative hemodynamic parameters include portal vein pressure, portal vein flow, and hepatic venous pressure gradient; however, there are still others potential valuable parameters, such as total liver inflow and hepatic artery flow. All the parameters are correlated closely and some internal modulating mechanisms, like hepatic arterial buffer response, occur to maintain stable hepatic inflow. To distinguish the unique importance of each hepatic and systemic parameter in different states during liver transplantation, we reviewed the published data and also conducted two transplant cases with different surgical strategies applied to achieve ideal portal inflow and pressure.

Keywords: Liver transplantation, Hemodynamics, Graft inflow modulation, Liver circulation, Small-for-size syndrome

Core tip: Even with the technical advancement of liver transplantation, there is still lack of consensus about the optimal range of the hepatic hemodynamic parameters intra-operatively. In this article, we review the physiology of liver hemodynamics in the normal population and also in the cirrhosis-related portal hypertension. The hemodynamic changes during liver transplantation with different graft types according to the primary hepatic circulation of the recipients are discussed. Finally, the flowchart applied in our center for performing graft inflow modulation according to systemic and hepatic hemodynamic parameters during liver transplantation is proposed in detail.