Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 18, 2016; 8(32): 1384-1391
Published online Nov 18, 2016. doi: 10.4254/wjh.v8.i32.1384
Systemic-to-pulmonary artery pressure ratio as a predictor of patient outcome following liver transplantation
Annette Rebel, Dung Nguyen, Brooke Bauer, Paul A Sloan, Amy DiLorenzo, Zaki-Udin Hassan
Annette Rebel, Dung Nguyen, Brooke Bauer, Paul A Sloan, Amy DiLorenzo, Zaki-Udin Hassan, Department of Anesthesiology and Surgery, Medical Center N 202, University of Kentucky, Lexington, KY 40536, United States
Author contributions: Rebel A and Bauer B collected and analyzed the data, and drafted the manuscript; Nguyen D, Sloan PA, DiLorenzo A and Hassan ZU provided analytical oversight and supervised the study; all authors contributed and revised the manuscript for importance; all authors have read and approved the final version to be published.
Institutional review board statement: The need for informed consent of study participants was waived by the Institutional Review Board since the de-identified data review demonstrated minimal risk to patient population.
Informed consent statement: The need for informed consent of study participants was waived by the Institutional Review Board.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at arebe2@email.uky.edu.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Annette Rebel, MD, Associate Professor, Department of Anesthesiology and Surgery, Medical Center N 202, University of Kentucky, 800 Rose Street, Lexington, KY 40536, United States. arebe2@uky.edu
Telephone: +1-859-3235956 Fax: +1-859-3231080
Received: June 22, 2016
Peer-review started: June 28, 2016
First decision: September 5, 2016
Revised: September 23, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: November 18, 2016
Processing time: 141 Days and 12.5 Hours
Abstract
AIM

To assess the value of the mean systemic-to-pulmonary artery pressure (MAP/mPAP) ratio for predicting outcomes following orthotopic liver transplant (OLT).

METHODS

A retrospective data analysis was performed and data (mean arterial blood pressure, mean pulmonary artery pressure and Cardiac Index) were collected at several points during OLT. Outcomes evaluated were duration of postoperative endotracheal intubation [ET; minutes after intensive care unit (ICU) arrival], length of ICU stay, total hospitalization and frequency of immediate postoperative complications. A total of 91 patients were included in the data analysis. Based on the intraoperative course of the MAP/mPAP ratio, 2 hemodynamic responses were identified: Group 1 (MAP/mPAP ratio increase during anhepatic period with postreperfusion recovery, n = 66); and Group 2 (MAP/mPAP ratio with no change during anhepatic period or decreased without recovery, n = 25).

RESULTS

The main finding was that the lack of increased MAP/mPAP ratio in the anhepatic period was associated with: (1) longer intubation times; and (2) prolonged ICU stays and total hospitalization time, when compared to patients with an increase in MAP/mPAP ratio during the anhepatic period.

CONCLUSION

The data from this retrospective study should raise awareness to the mean systemic to pulmonary artery pressure ratio as a potential indicator for poor outcome after OLT. Further prospective studies are needed for validation.

Keywords: Anesthesiology; Liver transplantation; Right heart function; Outcome; Morbidity

Core tip: The aim of this study was to assess the value of the mean systemic-to-pulmonary artery pressure (MAP/mPAP) ratio for predicting outcomes following orthotopic liver transplant. The intraoperative pattern of this ratio has not been previously described. Performing a retrospective analysis we identified 2 different MAP/mPAP patterns: Group 1 (MAP/mPAP ratio increase during anhepatic period with postreperfusion recovery, n = 66); and Group 2 (MAP/mPAP ratio with no change during anhepatic period or decreased without recovery, n = 25). The main finding was that the lack of increased MAP/mPAP ratio in the anhepatic period was associated with longer intubation times, and prolonged hospitalization time.