{"title":"活体肝移植术后早期同种异体移植物功能障碍的术中血流动力学监测和预测：一项系统综述。","authors":"Audrey E. Brown, John Roberts","doi":"10.1111/ctr.70074","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Multiple intraoperative hemodynamic parameters are associated with an increased risk of early allograft dysfunction (EAD) following living donor liver transplantation (LDLT); however, there is significant center-to-center variability in terms of which parameters are used. We sought to determine which intraoperative hemodynamic parameters are most predictive of EAD following LDLT.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This is a systematic review following PRISMA guidelines (PROSPERO ID: CRD42023409711). Receiver operating characteristic (ROC) analyses were used to compare predictive parameters.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 4399 articles were identified from 3 large, international databases (PubMed, Embase, and Web of Science). Eighteen articles fit the inclusion criteria. The most commonly evaluated hemodynamic parameter was the postreperfusion portal venous pressure (PVP). A postreperfusion PVP of <15–20 mmHg was consistently associated with lower rates of EAD and, in some cases, improvements in patient survival. Other hemodynamic parameters evaluated included portal venous flow, hepatic arterial flow, portal venous velocities, and the hyperperfusion index.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Hemodynamic measurements indicative of portal hyperperfusion, especially elevated PVP, have been consistently associated with the development of EAD. Intraoperative hemodynamics should be monitored on all LDLT recipients, with portal inflow modulation procedures indicated if portal hyperperfusion is present.</p>\n </section>\n </div>","PeriodicalId":10467,"journal":{"name":"Clinical Transplantation","volume":"39 2","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11775431/pdf/","citationCount":"0","resultStr":"{\"title\":\"Intraoperative Hemodynamic Monitoring and Prediction of Early Allograft Dysfunction Following Living Donor Liver Transplantation: A Systematic Review\",\"authors\":\"Audrey E. 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Eighteen articles fit the inclusion criteria. The most commonly evaluated hemodynamic parameter was the postreperfusion portal venous pressure (PVP). A postreperfusion PVP of <15–20 mmHg was consistently associated with lower rates of EAD and, in some cases, improvements in patient survival. Other hemodynamic parameters evaluated included portal venous flow, hepatic arterial flow, portal venous velocities, and the hyperperfusion index.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Hemodynamic measurements indicative of portal hyperperfusion, especially elevated PVP, have been consistently associated with the development of EAD. 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引用次数: 0
摘要
背景：多种术中血流动力学参数与活体肝移植（LDLT）术后早期同种异体移植物功能障碍（EAD）的风险增加有关；然而，就使用的参数而言，中心到中心的差异很大。我们试图确定哪些术中血流动力学参数最能预测LDLT后的EAD。方法：这是一项遵循PRISMA指南（PROSPERO ID: CRD42023409711）的系统评价。受试者工作特征（ROC）分析用于比较预测参数。结果：从3个大型国际数据库（PubMed、Embase和Web of Science）中共鉴定出4399篇文章。18篇文章符合纳入标准。最常评估的血流动力学参数是灌注后门静脉压（PVP）。结论：表明门脉高灌注的血流动力学测量，特别是PVP升高，一直与EAD的发展相关。术中应监测所有LDLT受者的血流动力学，如果存在门脉高灌注，应采用门脉流入调节程序。
Intraoperative Hemodynamic Monitoring and Prediction of Early Allograft Dysfunction Following Living Donor Liver Transplantation: A Systematic Review
Background
Multiple intraoperative hemodynamic parameters are associated with an increased risk of early allograft dysfunction (EAD) following living donor liver transplantation (LDLT); however, there is significant center-to-center variability in terms of which parameters are used. We sought to determine which intraoperative hemodynamic parameters are most predictive of EAD following LDLT.
Methods
This is a systematic review following PRISMA guidelines (PROSPERO ID: CRD42023409711). Receiver operating characteristic (ROC) analyses were used to compare predictive parameters.
Results
A total of 4399 articles were identified from 3 large, international databases (PubMed, Embase, and Web of Science). Eighteen articles fit the inclusion criteria. The most commonly evaluated hemodynamic parameter was the postreperfusion portal venous pressure (PVP). A postreperfusion PVP of <15–20 mmHg was consistently associated with lower rates of EAD and, in some cases, improvements in patient survival. Other hemodynamic parameters evaluated included portal venous flow, hepatic arterial flow, portal venous velocities, and the hyperperfusion index.
Conclusion
Hemodynamic measurements indicative of portal hyperperfusion, especially elevated PVP, have been consistently associated with the development of EAD. Intraoperative hemodynamics should be monitored on all LDLT recipients, with portal inflow modulation procedures indicated if portal hyperperfusion is present.
期刊介绍：
Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored.
Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include:
Immunology and immunosuppression;
Patient preparation;
Social, ethical, and psychological issues;
Complications, short- and long-term results;
Artificial organs;
Donation and preservation of organ and tissue;
Translational studies;
Advances in tissue typing;
Updates on transplant pathology;.
Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries.
Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.
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