Advertisement

Acid-Base Regulatory Mechanisms during Orthotopic Liver Transplantation

  • A. De Gasperi
Conference paper

Abstract

Orthotopic liver transplantation (OLT) is now recognised as a definite treatment for patients with chronic end-stage liver disease (ESLD) not responsive to medical or surgical treatment [1]: indications and contraindications to OLT have been redefined recently in a Consensus Conference (Consensus statement on indications for liver transplantation. Paris, June 22–23 1993. Hepatology 1994; 20: 63S–68S). In most groups one-year survival rate is greater than 80%, mortality in subsequent years low and quality of life for long-term survivors excellent.

Keywords

Mean Arterial Pressure Metabolic Acidosis Lactic Acidosis Orthotopic Liver Transplantation Metabolic Alkalosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Marsh JW, Miller SB, Carrol PB et al (1991) Medical evaluation and recipient selection for organ transplantation. In: Makowka L (ed) The handbook of transplantation management. RG Landes Company, Austin, pp 1–43Google Scholar
  2. 2.
    Aggarwal S (1994) Anesthetic management during liver transplantation. Transplant Proc 26: 321–324PubMedGoogle Scholar
  3. 3.
    Oster JR (1983) Acid base homeostasis and liver disease. In: Epstein M (ed) The kidney in liver disease, 2nd edn. Elsevier, New York, pp 147–182Google Scholar
  4. 4.
    Martin D (1986) Hemodynamic monitoring during liver transplantation. In: Winter PM, Kang YG (eds) Hepatic transplantation: anesthetic and perioperative management. Praeger, New York, pp 95–102Google Scholar
  5. 5.
    Moreau R, Hadengue A, Soupison T et al (1993) Arterial and mixed venous acid base status in patients with cirrhosis. Influence of liver failure. Liver 13: 20–24PubMedGoogle Scholar
  6. 6.
    Moreau R, Lee SS, Soupisson T et al (1988) Abnormal tissue oxygenation in patients with cirrhosis and liver failure. J Hepatol 7: 98–105PubMedCrossRefGoogle Scholar
  7. 7.
    Steib A, Freys G, Gohard R et al (1992) Tissue oxygenation during liver transplantation. Crit Care Med 20: 977–983PubMedCrossRefGoogle Scholar
  8. 8.
    Herrman R, McIntyre N (1991) Aminoacid metabolism, urea production and pH regulation. In: McIntyre N, Benhamou JP, Bircher J et al (eds) Oxford textbook of clinical hepatology. Oxford University Press, Oxford, pp 157–174Google Scholar
  9. 9.
    Hawker F (1992) Liver failure in the patient with chronic liver disease. In: Hawker F. The Liver. WB Saunders, London, pp 153–183Google Scholar
  10. 10.
    Carmichael FJ, Lindop MJ, Farman JV (1985) Anesthesia for hepatic transplantation. Cardiovascular an metabolic alterations and their management. Anest Analg 64: 108–116CrossRefGoogle Scholar
  11. 11.
    Kang YG, Gelman S (1987) Liver transplantation. In: Gelman S (ed) Anesthesia and organ transplantation. WB Saunders, London, pp 139–185Google Scholar
  12. 12.
    Stieber AC, Marsh JW, Starzl TE (1989) Preservation of the retrohepatic vena cava during recipient hepatectomy for orthotopic liver transplantation. Sur Gynecol Obstet 168: 542–544Google Scholar
  13. 13.
    Aggarwal S, Kang YG, Freeman J et al (1993) Postreperfusion syndrome: hypotension after reperfusion of the transplanted liver. J Crit Care 8: 154–160PubMedCrossRefGoogle Scholar
  14. 14.
    Pearson JD, Gelman S (1992) Liver transplantation. In: Kaplan J (ed) Anesthesia in vascular surgery, Grune Stratton, New York, pp 451–485Google Scholar
  15. 15.
    Kang YG (1996) Update on anesthesia for orthotopic liver transplantation. Transplantology 7: 12–16Google Scholar
  16. 16.
    Fath JJ, Ascher NL, Konstantinided FN et al (1984) Metabolism during hepatic transplantation: indicators of allograft function. Surgery 96: 664–672PubMedGoogle Scholar
  17. 17.
    Ramsay MAE, Swygert TH (1992) Anesthesia for hepatic trauma, hepatic resection and liver transplantation. In: Strunin L, Thomson S (eds) The liver and anesthesia. Clin Anaesthesiol 6: 863–894. Ballière Tindall, LondonGoogle Scholar
  18. 18.
    Ozier Y, Präs Jude N, Moncorgé C et al (1987) Anesthésie et réanimation peropératoire au cours de la transplantation hépatique. Ann Fr Anésth Réanim 6: 507–519PubMedCrossRefGoogle Scholar
  19. 19.
    Shangraw RE, Winter R, Hromco J et al (1994) Amelioration of lactic acidosis with dichloroacetate during liver transplantation in humans. Anesthesiology 81: 1127–1138PubMedCrossRefGoogle Scholar
  20. 20.
    Leatherdale BA, Chase RA, Rogers J et al (1980) Foreharm glucose uptake in cirrhosis and its relationship to glucose tolerance. Clin Sci 59: 191–198PubMedGoogle Scholar
  21. 21.
    Buchalter SE, Crain MR, Kriesberg R (1989). Regulation of lactate metabolism in vivo. Diabetes Metab Rev 5: 379–391PubMedCrossRefGoogle Scholar
  22. 22.
    Koller J, Wieser C, Furtwangler W et al (1991) Orthotopic liver transplantation and perioperative lactate metabolism. Transplant Proc 23: 1989–1990PubMedGoogle Scholar
  23. 23.
    Mc Ginty M, Cottam S, Pannell M et al (1995) Can intraoperative serum lactate levels predict early graft function following liver transplantation? Liver Transplant Surg 1: 440 (Abs)Google Scholar
  24. 24.
    Gores GJ, Ferguson DM, Ludwig J et al (1990) Effect of acidosis during cold ischemic storage on liver viability following transplantation in rat. Transplant Proc 22: 488–489PubMedGoogle Scholar
  25. 25.
    Driscoll DF, Bistrian BR, Jenkins RJ et al (1987) Development of metabolic alkalosis after massive transfusion during orthotopic liver transplantation. Crit Care Med 15: 905–908PubMedCrossRefGoogle Scholar
  26. 26.
    Peral AI, Gomez Arnau JI, Garcia Del Valle S et al (1995) Metabolic alkalosis following orthotopic liver transplantation. Clin Intens Care 6: 273–277CrossRefGoogle Scholar
  27. 27.
    Fortunato FL, Kang YG, Aggarwal S et al (1987) Acid base status during and after orthotopic liver transplantation. Transplant Proc 19: 59–60PubMedGoogle Scholar
  28. 28.
    Svensson KL, Persson H, Henrikson A et al (1989) Whole body gas exchange, aminoacid and lactate clearance as indicators of inizial and early allograft viability in liver transplantation. Surgery 105: 472–480PubMedGoogle Scholar
  29. 29.
    Begliomini B, DeWolf A, Freeman J et al (1989) Intraoperative lactate levels can predict graft function after liver transplantation. Anesthesiology 71: A 180 (Abs)Google Scholar
  30. 30.
    Steltzer H, Tuchy G, Hiesmayer M et al (1993) Oxygen kinetic during liver transplantation: relationship between delivery and consumption. J Crit Care 8: 12–16PubMedCrossRefGoogle Scholar
  31. 31.
    De Gasperi A, Mazza E, Corti A et al (1997) Lactate blood levels in the perioperative period of orthotopic liver transplantation. Int J Clin Lab Res 27: 123–128PubMedCrossRefGoogle Scholar
  32. 32.
    Ozier Y, Eyrolle L, Mathey C et al (1988) Arterial to end tidal CO2 tension difference during human orthotopic liver transplantation. Anesthesiology 69: A282 (Abs)CrossRefGoogle Scholar
  33. 33.
    Just B, Delva E, Camus Y et al (1990) Adjustment of ventilation to control acidosis without sodium bicarbonate during liver transplantation. Anesthesiology 73: A296 (Abs)Google Scholar
  34. 34.
    Klinck JR, Berridge JC (1995) Liver transplantation. In: Park G, Kang YG (eds) Anesthesia and intensive care for patients with liver disease. Butterworth Heinemann, London, pp 111–128Google Scholar
  35. 35.
    Hindman BJ (1990) Sodium bicarbonate in the treatment of subtypes of acute lactic acidosis: physiological considerations. Anesthesiology 72: 1064–1076PubMedCrossRefGoogle Scholar
  36. 36.
    Zhou HZ, Malhotra D, Shapiro JI (1991) Contractile dysfunction during metabolic acidosis on canine hemodynamics and left ventricular function. Am J Physiol 258: H1 193–H1 199Google Scholar
  37. 37.
    Bogdonoff DL, Spiekermann BF (1995) Should acidosis during liver transplantation be treated? Anesthesiology 82: 1540–1541 (letter)PubMedCrossRefGoogle Scholar
  38. 38.
    Shangraw RE (1995) In reply to Bogdonoff DL. Anesthesiology 82: 1541 (letter)CrossRefGoogle Scholar
  39. 39.
    Ritter JM, Doktor HS, Benjamin N (1990) Paradoxical effect of bicarbonate on cytoplasmic pH. Lancet 335: 1243–1246PubMedCrossRefGoogle Scholar
  40. 40.
    Shangraw RE, Jahoor F (1995) Role of urea synthesis in the metabolic alkalosis following liver transplantation. Liver Transplant Surg 1: 451 (Abs)Google Scholar
  41. 41.
    Jackson EK (1996) Diuretics. In: Hardman JG, Limbird LE, Molinoff PB et al. Pharmacological basis of therapeutics. Mc Graw Hill, New York, pp 691–695Google Scholar

Copyright information

© Springer-Verlag Italia, Milano 1998

Authors and Affiliations

  • A. De Gasperi

There are no affiliations available

Personalised recommendations