Changes in arterial blood gas and electrolytes during non-bypass orthotopic liver transplantation

Objective To investigate the changes of arterial blood gas (ABG) and electrolytes as well as the effects of hepatic venous blood after reperfusion on these changes during orthotopic liver transplantation (OLT) without anhepatic veno-venous bypass. Methods Eighty OLT for end-stage liver disease were performed under general anesthesia with continuously monitoring of hemodynamics. ABG and electrolytes were also measured before anesthesia, before cross-clamping of the portal vein, 30 min and 60 min in anhepatic phase, 5 min and 30 min after unclamping of portal vein and at the end of the operation. In addition, hepatic venous blood samples were also collected and analysed after portal vein reperfusion in 70 of the 80 patients. The disturbances in hemodynamics and blood gas or electrolytes were corrected according to the measurements. Results There were significant changes in hemodynamics during the operation. MAP decreased and HR increased during anhepatic period, especially in clamping and unclamping the portal vein and vena cava. The blood pressure in 57 patients were supported with vasoconstricter. Arterial pH declined after 30 min of anhepatic phase. 5 min after reperfusion PaCO 2 increased 4～5 mm Hg in average. BE decreased after clamping of the portal vein. Serum potassium level and BE had greater individual differences, with 2.6～6.1 mmol/L of potassium level and -13～+9 of BE respectively. Hypocalcemia occurred during the operation. Serum sodium was maintained stably. There were tremendous increases in potassium, PCO 2, and severe decreases in sodium, calcium, pH and BE in hepatic vein blood samples. Conclusion In orthotopic liver transplantation without veno-venous bypass, the hemodynamics and homeostasis were seriously disturbed by clamping and unclamping the portal vein and inferior vena cava. (Shanghai Med J, 2004,27∶817-820)