Statistical Modeling of Hemodynamic Changes During Orthotopic Liver Transplantation: Predictive Value for Outcome and Effect of Marginal Donors

Aim: This study analyzed hemodynamic recordings collected on a beat-to-beat basis during orthotopic liver transplantation (OLT). The first aim was to construct a graphic that will represent hemodynamic profile during OLT. The second aim was to compare the intraoperative hemodynamic pattern of survivors versus nonsurvivors and those who received a liver from normal versus marginal donors.

Methods: Hemodynamic data (including cardiac output, cardiac index, stroke volume [SV] and SV index, systemic vascular resistance [SVR] and SVR index, mean arterial pressure, and heart rate) were collected from 100 consecutive adult OLT patients with the use of a lithium dilution cardiac output (LiDCO plus) monitor. A LOESS (Robust Locally Weighted Regression and Smoothing Scatterplots) smoother was used to give a more easily interpreted graph. Patients were grouped with respect to survival at 30 days (survivors vs nonsurvivors) and quality of graft (marginal vs normal).

Results: We constructed graphics that represented all intraopetative hemodynamic data during OLT for 100 consecutive procedures. It confirmed hyperdynamic circulation during OLT. Statistical analysis did not reveal significant differences regarding intraoperative hemodynamic data between survivors and nonsurvivors, or between patients receiving normal versus marginal grafts.

Conclusion: This study shows changes in the hemodynamic profile during OLT, measured on a beat-to-beat basis. Intraoperative hemodynamic changes did not predict patients who did not survive OLT. Beat-to-beat monitoring did not reveal significant hemodynamic instability following transplantation of marginal grafts.