The Validity of Central Venous to Arterial Carbon Dioxide Difference to Predict Adequate Fluid Management during Living Donor Liver Transplantation. A prospective observational study.

Abstract Background: to assess the validity of Central and Pulmonary CO2 gaps to predict and guide fluid management during liver transplantation. Methods: Intraoperative fluid management was guided by pulse pressure variations (PPV). PPV of ≥15% triggered fluid resuscitation with 250 ml albumin 5% boluses to restoret PPV to <15%. Simultaneous blood sampling from central venous and pulmonary artery catheters (PAC) were clolected to calculate central and pulmonary CO2 gap. Patients were considered Fluid Responsive (FRS) if fluid boluses restored PPV to <15% and Fluid non-Responsive (FnRS) if not. CO and lactate and their correlation to CO2 gaps were also recorded. Results: The discriminative ability of Central and Pulmonary CO2 gaps between the two statuses (FRS and FnRS) was poor. AUC of ROC were 0.698 and 0.570 respectively. The Central CO2 gap was significantly higher in FRS than FnRS (P=0.016), with no difference in Pulmonary CO2 gap between both statuses. conclusion: Central and the Pulmonary CO2 gaps cannot be used alone as valid tools to predict fluid responsiveness and guide fluid management during liver transplantation. CO2 gaps do not correlate well with the changes in PPV or CO Trial registration: Clinicaltrials.gov NCT03123172. Registered on 31-march-2017

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The validity of central venous to arterial carbon dioxide difference to predict adequate fluid management during living donor liver transplantation. A prospective observational study

BMC Anesthesiology ◽

10.1186/s12871-019-0776-9 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Mohamed ELAyashy ◽

Hisham Hosny ◽

Amr Hussein ◽

Ahmed AbdelAal Ahmed Mahmoud ◽

Ahmed Mukhtar ◽

...

Keyword(s):

Carbon Dioxide ◽

Liver Transplantation ◽

Observational Study ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Prospective Observational Study ◽

Fluid Management ◽

Donor Liver ◽

Central Venous ◽

Donor Liver Transplantation

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The Validity of Central Venous to Arterial Carbon Dioxide Difference to Predict Adequate Fluid Management during Living Donor Liver Transplantation: A Prospective Observational Study.

10.21203/rs.2.168/v1 ◽

2019 ◽

Author(s):

Hisham Hosny ◽

Mohamed Elayashy ◽

Amr Hussein ◽

Ahmed Abdelaal Ahmed Mahmoud ◽

Ahmed Mukhtar ◽

...

Keyword(s):

Liver Transplantation ◽

Fluid Responsiveness ◽

Fluid Management ◽

Central Venous ◽

Predict Fluid Responsiveness ◽

Discriminative Ability ◽

Donor Liver Transplantation ◽

Pulmonary Artery Catheters ◽

Data Points ◽

End Stage

Abstract Background: Patients with End-stage liver disease undergoing orthotopic liver transplantation are prone to serious hemodynamic and metabolic derangements. The study aimed to assess the validity of central and pulmonary veno-arterial CO2 gradients to predict fluid responsiveness and to guide fluid management during liver transplantation. Methods: In adult recipients of liver transplantation, ASA III to IV, pulse pressure variations (PPV) guided intraoperative fluid management. PPV of ≥15% (Fluid Responding Status-FRS) indicated fluid resuscitation with 250 ml albumin 5% boluses repeated if required to correct PPV to <15% (Fluid non-Responding Status-FnRS). Samples from central venous and pulmonary artery catheters (PAC) were collected simultaneously to calculate both the central venous to arterial CO2 gap [C(v-a) CO2 gap] and the pulmonary venous to arterial CO2 gap [Pulm(p-a) CO2 gap]. Results: Primary outcome was the sensitivity of central venous CO2 gap to differentiate between fluid responding and non-responding states with 67 data points recorded (20 FRS and 47 FnRS). The discriminative ability of central and pulmonary CO2 gaps between the two statuses (FRS and FnRS) was poor with AUC of ROC of 0.698 and 0.570 respectively. The central CO2 gap was significantly higher in FRS than FnRS (P=0.016), with no difference in pulmonary CO2 gap between both statuses. The central and pulmonary CO2 gaps were weakly correlated to PPV [r=0.291, (P=0.017) and r=0.367, (P=0.002) respectively]. No correlation between both CO2 gaps and both CO and lactate could be seen. Conclusion: The Central and the Pulmonary CO2 gaps cannot be used as valid tools to predict fluid responsiveness and to guide fluid management during liver transplantation. CO2 gaps also do not correlate well with the changes in PPV or CO.

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Uric Acid as a Predictor for Early Allograft Dysfunction after Living Donor Liver Transplantation: A Prospective Observational Study

Journal of Clinical Medicine ◽

10.3390/jcm10122729 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2729

Author(s):

Li-Min Hu ◽

Hsin-I Tsai ◽

Chao-Wei Lee ◽

Hui-Ming Chen ◽

Wei-Chen Lee ◽

...

Keyword(s):

Liver Transplantation ◽

Uric Acid ◽

Observational Study ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Prospective Observational Study ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Allograft Dysfunction ◽

Early Allograft Dysfunction

Early allograft dysfunction (EAD) is a postoperative complication that may cause graft failure and mortality after liver transplantation. The objective of this study was to examine whether the preoperative serum uric acid (SUA) level may predict EAD. We performed a prospective observational study, including 61 donor/recipient pairs who underwent living donor liver transplantation (LDLT). In the univariate and multivariate analysis, SUA ≤4.4 mg/dL was related to a five-fold (odds ratio (OR): 5.16, 95% confidence interval (CI): 1.41–18.83; OR: 5.39, 95% CI: 1.29–22.49, respectively) increased risk for EAD. A lower preoperative SUA was related to a higher incidence of and risk for EAD. Our study provides a new predictor for evaluating EAD and may exert a protective effect against EAD development.

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